What Is Acute Pulmonary Edema?

Acute pulmonary edema is one of the cardiology emergencies. Its clinical manifestations are: sudden severe breathing difficulty, sitting breath, with cough, pink foam-like sputum often coughing, patient irritability, cyanosis of lips, sweating, The heart rate increases, and both lungs are covered with wet rales and wheezing. In severe cases, it can cause syncope and cardiac arrest.

Acute pulmonary edema is one of the cardiology emergencies. Its clinical manifestations are: sudden severe breathing difficulty, sitting breath, with cough, pink foam-like sputum often coughing, patient irritability, cyanosis of lips, sweating, The heart rate increases, and both lungs are covered with wet rales and wheezing. In severe cases, it can cause syncope and cardiac arrest.

Causes of acute pulmonary edema

This disease mostly occurs: acute diffuse damage of the myocardium leads to weakened myocardial contractility, such as acute generalized myocardial infarction, acute myocarditis, etc .; acute mechanical obstruction caused by overload of heart pressure and obstruction of blood discharge, such as severe hypertension Aortic valve stenosis or mitral valve stenosis; Acute cardiac volume overload, such as acute myocardial infarction or infective endocarditis, heart trauma, etc., causing heart valve damage, chordae rupture, papillary muscle dysfunction, ventricle Interval perforation, etc. In addition, venous blood transfusion and excessive infusion can cause acute pulmonary edema; acute ventricular diastole is limited, such as acute cardiac tamponade caused by acute massive pericardial effusion, which leads to reduced cardiac output and systemic congestion Etc .; Increased tissue metabolism and accelerated circulation such as hyperthyroidism and severe anemia.

Clinical Observation:

Most patients with acute pulmonary edema have many causes before the attack, such as full meals, hard stools, mood swings, fatigue, acute infections, etc.

Clinical manifestations of acute pulmonary edema

According to the development of edema, it is divided into pulmonary interstitial edema and alveolar edema.

Pulmonary interstitial edema

Symptoms: Patients often feel chest tightness, fear, cough, and difficulty breathing.

Signs: pale, rapid breathing, tachycardia, elevated blood pressure, wheezing sounds can be heard.

X-ray examination: pulmonary veins were blurred, hilar shadows were unclear. The lung lobules are widened to form Kerley A and B lines.

Blood gas analysis: PaCO2 is low, pH , and respiratory alkalosis.

Alveolar edema

Symptoms: The patient is paler, has more difficulty breathing, and has cold sweats.

Signs: Lips on the lips and nail beds, a large amount of pink foam sputum, patients with general anesthesia can show increased respiratory resistance and cyanosis, a large amount of pink foam sputum sprayed through the tracheal tube; auscultation of both lungs: full lung rales, decreased blood pressure

X-ray examination: It is mainly alveolar dense shadows, which are fused into irregular flakes. The diffuse distribution is confined to one side or one leaf, or it is found on both sides of the hilum. Typical

Blood gas analysis: PaCO2 is high and / or PaO2 is low, pH is low, showing hypoxemia and respiratory acidosis

Diagnosis and diagnosis of acute pulmonary edema

The diagnosis of pulmonary edema is based on symptoms, signs, and X-ray findings.

Early diagnosis method: Pulmonary arterial wedge pressure and plasma colloid osmotic pressure are measured. If the pressure difference is less than 4mmHg, pulmonary edema is unavoidable.

Continuous measurement of chest basal impedance (thoracic fluid index, TFl), and a decrease in TFI revealed increased pulmonary fluid.

Acute pulmonary edema treatment principles

Etiology treatment: positive measures to alleviate and eliminate pulmonary edema.

Maintain airway, fully provide 02 and mechanical ventilation treatment, and correct hypoxemia.

Reducing the hydrostatic pressure of the pulmonary blood vessels, increasing the plasma colloid osmotic pressure, and improving the permeability of the pulmonary capillaries.

Keep patients calm and prevent and control infections.

You should take a seated position with your legs drooping.

Rescue and nursing of acute pulmonary edema

1) Posture: Take a sitting or semi-recumbent position with your legs drooping to reduce venous return.

2) Oxygen absorption: Wet with 20% -30% ethanol.

3) Sedatives: Subcutaneous or intramuscular injection of 5-10 mg of morphine or 50 mg of pethidine. It is contraindicated in patients with severe pulmonary disease in coma shock.

4) Diuretics: Intravenous rapid diuretics reduce the amount of returning blood.

5) Cardiotonic agent: Slowly and intravenously inject cedilan 0.2-0.4mg

6) Vasodilators: reduce pre and post load

7) Aminophylline: relieve bronchospasm, slowly inject after dilution

8) Glucocorticoids: Dexamethasone reduces capillary permeability and reduces peripheral vascular resistance.

9) Closely observe your consciousness, complexion, heart rate, heart rhythm, breathing, blood pressure, urine volume, drip rate, medication response, etc.

10) Timely, accurate and detailed records.