The following symptoms and complaints may indicate pulmonary edema: Dyspnea (shortness of breath)-at first, only on exertion. Rales (RG) Tachypnea – accelerated breathing. Central cyanosis – bluish discoloration of skin and central mucous membranes/tongue in the absence of oxygen. Cough, bloody foam Cold sweats
Pathogenesis (development of disease) In pulmonary edema, a cardiac cause can be distinguished from a noncardiac cause. Fluid leakage from the pulmonary capillaries (small pulmonary vessels) into the interstitium (intercellular space; interstitial pulmonary edema) and/or alveolar space (intraalveolar pulmonary edema) occurs in pulmonary edema. The cause may be increased pulmonary capillary pressure, decreased colloid osmotic … Pulmonary Edema: Causes
General measures Seated storage Oxygen administration (target sO2 (oxygen saturation) > 90%), non-invasive/invasive ventilation if necessary. Sedation (tranquilization) Cardiac (heart-related) pulmonary edema: preload reduction, increase in cardiac pump function (see therapy heart failure/cardiac insufficiency). Toxic pulmonary edema: if necessary, extracorporeal membrane oxygenation (ECMO); intensive care technique in which a machine partially or completely takes over … Pulmonary Edema: Therapy
Respiratory System (J00-J99) ARDS (adult respiratory distress syndrome) – life-threatening acute damage to the lungs; often associated with multiorgan failure in the setting of SIRS (systemic inflammatory response syndrome; clinical picture resembling sepsis). Bronchial asthma Cardiac pulmonary edema – accumulation of water in the lungs due to heart disease. Pulmonary hemorrhage, unspecified Noncardiac pulmonary edema … Pulmonary Edema: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by pulmonary edema: Respiratory system (J00-J99) ARDS (adult respiratory distress syndrome) – life-threatening acute damage to the lungs; often associated with multiorgan failure in the setting of SIRS (systemic inflammatory response syndrome; clinical picture resembling sepsis). Cardiovascular system (I00-I99). Cardiovascular failure
Pulmonary edema can be divided into the following stages: Stage Description Interstitial pulmonary edema Edema (fluid accumulation) is located primarily in the connective tissue supporting framework of the lung and the interstitium (space between cells) Alveolar pulmonary edema Edema within the pulmonary alveoli (air sacs) Foaming Asphyxia, respiratory exhaustion Respiratory depression (impending asphyxia)
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin, mucous membranes and sclerae (white part of the eye) [Central cyanosis – bluish discoloration of skin and central mucous membranes, e.g. tongue]. Auscultation (listening) of the heart [due … Pulmonary Edema: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count Differential blood count Inflammatory parameters – CRP (C-reactive protein) or PCT (procalcitonin). HbA1c Blood gas analysis (ABG); Note: Interpretation by venous ABG is difficult; arterial ABG is indicated to support the clinical diagnosis of suspicion. TSH NT-proBNP (N-terminal pro brain natriuretic peptide) – to … Pulmonary Edema: Test and Diagnosis
Therapeutic target Stabilization Measures for acute pulmonary edema: Patient is placed in a sitting body position with lower extremities hanging down. Oxygen administration (10 l/min; target sO2 (oxygen saturation) > 90%), noninvasive ventilation with high-flow oxygen (up to 50?l/min)/invasive ventilation if necessary. Sedation (sedation; low-dose i.v. morphine). If there is marked fluid overload of the … Pulmonary Edema: Drug Therapy
Obligatory medical device diagnostics. Continuous monitoring of vital signs: Blood pressure (RR): blood pressure measurement/if necessary, invasive blood pressure measurement. Pulse/heart rate (HR) Respiratory rate (AF) Blood oxygen saturation (SpO2) (pulse oximetry; measurement of oxygen saturation of arterial blood and pulse rate). X-ray of the thorax (X-ray thorax/chest), in two planes [enhanced pulmonary vascular drawing]. … Pulmonary Edema: Diagnostic Tests
To prevent pulmonary edema, attention must be paid to reducing individual risk factors. Behavioral risk factors Drug use Heroin (intravenous, i.e., through the vein). Environmental stress – intoxications Intoxication – flue gas, chlorine, phosgene, ozone, nitrous gases (nitrogen oxides), etc. Other risk factors High altitude pulmonary edema (HAPE) – fluid accumulation (edema) in the lungs … Pulmonary Edema: Prevention
Medical history (history of illness) represents an important component in the diagnosis of pulmonary edema. Family history What is the general health of your family members? Social history What is your profession? Current medical history/systemic history (somatic and psychological complaints). What symptoms have you noticed? Do you suffer from shortness of breath?* How long has … Pulmonary Edema: Medical History
