Acute pulmonary edema is a violation of blood and lymph circulation, which causes an active exit of fluid from the capillaries into the tissue of the named organ, which ultimately provokes a violation of gas exchange and leads to hypoxia. Acute edema increases rapidly (the duration of an attack lasts from half an hour to three hours), which is why even with the resuscitation started on time, it is not always possible to avoid a fatal outcome.
How does the development of acute pulmonary edema
Acute pulmonary edema, the cause of death in many patients, develops as a result of blood serum infiltration into lung tissue, where it is collected in such an amount that the air passage is greatly reduced.
Initially, the named edema has the same character as the edema of other organs. But the structures that surround the capillaries are very thin, because of which the fluid immediately begins to enter the cavity of the alveoli. By the way, it appears in the pleural cavities, however, to a much lesser extent.
Diseases that may cause acute pulmonary edema
Acute pulmonary edema is the cause of death in the course of many diseases, although in some cases it can still be stopped with medication.
Diseases that can provoke pulmonary edema include pathologies of the cardiovascular system, including damage to the heart muscle during hypertension, congenital malformations, and congestion in the pulmonary circulation.
No less frequent causes of pulmonary edema are severe skull injuries, brain hemorrhages of various etiologies, as well as meningitis, encephalitis and various brain tumors.
It is natural to assume the cause of pulmonary edema in diseases or injuries of the respiratory system, such as pneumonia, inhalation of toxic substances, chest injuries, and allergic reactions.
Surgical pathologies, poisoning, insulin shock and burns can also lead to the described edema.
Types of pulmonary edema
In patients, two main, radically different types of pulmonary edema are most often observed:
- cardiogenic (cardiac pulmonary edema) caused by left ventricular failure and stagnation of blood in the lungs;
- non-cardiogenic, caused by increased permeability, acute damage to the named organ, or acute respiratory distress syndrome;
- Non-cardiogenic toxic edema is considered separately.
However, despite the fact that the causes of their occurrence are different, these edema can be very difficult to differentiate due to similar clinical manifestations of the attack.
Pulmonary edema: symptoms
Emergency care provided for pulmonary edema on time nevertheless gives the patient a chance to survive. For this, it is important to know all the symptoms of this pathology. They manifest themselves quite clearly and are easily diagnosed.
- At the beginning of the development of the attack, the patient often coughs, hoarseness builds up, and his face, nail plates and mucous membranes become cyanotic.
- Choking intensifies, accompanied by a feeling of tightness in the chest and pressing pain. To facilitate the patient is forced to sit down and sometimes lean forward.
- Very quickly the main signs of pulmonary edema also appear: rapid breathing, which becomes hoarse and bubbling, weakness and dizziness appear. Veins in the neck swell.
- When coughing, pink foaming sputum is released. And when the condition worsens, it can also stand out from the nose. The patient is scared, his consciousness may be confused. The limbs, and then the whole body, become wet with cold, sticky sweat.
- The pulse rises to 200 beats per minute.
Features of toxic pulmonary edema
A somewhat different picture is toxic pulmonary edema. It is caused by poisoning with barbiturates, alcohol, as well as the penetration of poisons, heavy metals or nitric oxides into the body. A burn of lung tissue, arsenic poisoning, uremia, diabetic, and hepatic coma can also provoke the described syndrome. Therefore, any severe attack of suffocation that appears in these situations should make pulmonary edema suspect. Diagnosis in these cases should be thorough and competent.
Toxic edema often occurs without characteristic symptoms. For example, with uremia, very poor external signs in the form of chest pain, dry cough and tachycardia do not correspond to the picture visible during x-ray examination. The same situation is typical of toxic pneumonia, and in the case of poisoning with metal carbonites. And poisoning with nitrogen oxides can be accompanied by all the signs of edema described above.
First non-drug help for pulmonary edema
If the patient has symptoms associated with pulmonary edema, emergency care should be provided to him even before being placed in the intensive care unit. The necessary measures are carried out by the ambulance team on the way to the hospital.
- The patient is given a semi-sitting position.
- Restraint clothing is unfastened on it, foam is removed from the upper respiratory tract. And to prevent its formation, oxygen is inhaled through a 30% solution of ethyl alcohol along with intravenous administration of 15 ml of glucose solution. In case of strong foam release, endotracheal administration of 2 ml of ethanol (96%) is carried out using trachea puncture.
- One of the fastest ways to reduce pressure in the pulmonary circulation is bloodletting. As a rule, 300 ml of blood is extracted, thereby significantly reducing congestion in the lungs. But with arterial hypotension or a heart attack that caused pulmonary edema, the consequences of this procedure can be severe.
- An alternative to bloodletting is the application of moderately tight tourniquets to 4 limbs, which also contributes to the unloading of the pulmonary circulation. In this case, be sure to check the pulsation below the bundles and keep them no more than half an hour, after which the bundles should be loosened, and then applied again. A direct contraindication for this procedure is thrombophlebitis.
Medication for pulmonary edema
The variety of manifestations that accompany the attack has led to the fact that many drugs are used in medicine that can relieve acute pulmonary edema. In this case, the cause of death may lie not only in the pathological state itself, but also in improperly selected treatment.
One of the drugs used to stop edema is morphine. It is especially effective if the attack was caused by hypertension, mitral stenosis or uremia. Morphine reduces shortness of breath, inhibiting the respiratory center, relieves tension and anxiety in patients. But at the same time, it is able to increase intracranial pressure, which is why its use in patients with cerebrovascular disorders should be very careful.
To reduce hydrostatic intravascular pressure in pulmonary edema, “Lasix” or “Furosemide” are used intravenously. And heparin therapy is used to improve pulmonary blood flow. Heparin is administered bolus (jet) at a dose of up to 10,000 units intravenously.
Cardiogenic edema, in addition, requires the use of cardiac glycosides (Nitroglycerin), and non-cardiogenic edema, glucocorticoids.
Severe pains are relieved with the help of “Fentanyl” and “Droperidol” preparations. If you manage to stop the attack, the therapy of the underlying disease begins.
Pulmonary edema: consequences
Even if the relief of pulmonary edema was successful, the treatment does not end there. After such an extremely difficult condition for the whole organism, patients often develop serious complications, most often in the form of pneumonia, which in this case is very difficult to treat.
Oxygen starvation affects almost all the organs of the victim. The most serious consequences of this may be cerebrovascular accidents, heart failure, cardiosclerosis and ischemic organ damage. These conditions can not do without constant and enhanced medical support, they, despite the arrested acute pulmonary edema, are the cause of the death of a large number of patients.