Download Acute pulmonary edema

Dr MH Soltani
cardiologist
 Pulmonary
edema is a
condition characterized by fluid
accumulation in the lungs
caused by back pressure in the
lung veins. This results from
malfunctioning of the heart.

Fluid backs up into the veins of the lungs.
Increased pressure in these veins forces
fluid out of the vein and into the air
spaces (alveoli). This interferes with the
exchange of oxygen and carbon dioxide
in the alveoli.
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Edema occurs when physiologic
resorption of fluid via lymphatic's is
overwhelmed
Causes usually divided into
“hydrostatic” and “increased capillary
permeability”, but both mechanisms can
occur in the same patient!
Chest radiography, when combined with
clinical data, helps distinguish pathologic
cause in vast majority of cases
Normally, excess
hydrostatic
transudate from
pulmonary
capillaries is filtered
into
peribronchovascular
lymphatics and
removed
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In hydrostatic edema,
transudate
accumulates in the
interstitium initially,
only entering alveoli
in severe cases
In permeability
edema associated
with diffuse alveolar
damage (DAD),
exudate fills the
interstitium and the
alveoli
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The lungs can accommodate
increases in fluid: the
lymphatic flow can increase 310x before edema develops
Higher hydrostatic pressures
force fluid through endothelial
cell pores, but the tighter
junctions of epithelial cells
prevent fluid from entering
alveoli until pulmonary
capillary pressures reach ~ 40
mm Hg, causing stress failure

Pulmonary edema is a complication of a
myocardial infarction (heart attack), mitral
or aortic valve disease, cardiomyopathy,
or other disorders characterized by
cardiac dysfunction.
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Extreme shortness of breath, severe
difficult breathing
Feeling of "air hunger" or "drowning"
"Grunting" sounds with breathing
Inability to lie down
Rales
Wheezing
Anxiety
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Restlessness
Cough
Excessive sweating
Pale skin
Nasal flaring
Coughing up blood
Breathing, absent temporarily
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Listening to the chest with a stethoscope
(auscultation) may show crackles in the
lungs or abnormal heart sounds.
A chest x-ray may show fluid in the lung
space.
An echocardiogram may be performed in
addition to (or instead of) a chest x-ray.
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Blood oxygen levels (low)
A chest X-ray may reveal the following:
Fluid in or around the lung space
Enlarged heart
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An ultrasound of the heart
(echocardiogram) may reveal the
following:
Weak heart muscle
Leaking or narrow heart valves
Fluid surrounding the heart
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Lasix IV (high dose if pt. prev. on it)
Morphine (at least 4mg IV to start)
Nitroglycerin (SL, paste, or drip)
Oxygen (100% NRBM, then PAP)
Positive pressure ventilation
(noninvasive bilevel positive airway
pressure “BiPAP™” or intubation)
NASAL
CANNULA.
The nasal cannula,
or nasal prongs, is
used at flow rates
of 1 to 6 L/min.
Approximate
oxygen
concentrations
of 24% (at 1 L/min)
to 44% (at 6 L/min)
can be achieved.
SIMPLE FACE MASK.
A simple face mask is
used to deliver oxygen
concentrations
of 40% to 60% for shortterm oxygen therapy or
in an emergency. A
minimum flow rate
of 5 L/min is needed to
prevent the rebreathing
of exhaled air.
PARTIAL
REBREATHER MASK.
A partial rebreather mask
provides oxygen
concentrations
of 60% to 75%, with flow
rates of 6 to 11 L/min.
NON-REBREATHER
MASK.
A non-rebreather
mask provides the
highest concentration
of the low-flow
systems and can
deliver an Fio2 greater
than 90%,