]Pulmonary Edema is extravasation of fluid from the pulmonary vasculature into the interstitium and alveoli
of the lung
The formation of pulmonary edema may be caused by 4 major pathophysiologic mechanisms:
(1) imbalance of Starling forces (ie, increased pulmonary capillary pressure, decreased plasma oncotic pressure, increased negative interstitial pressure),
(2) damage to the alveolar-capillary barrier,
(3) lymphatic obstruction
(4) idiopathic or unknown mechanism.
and it can be result of inadequate functioning of the heart or circulatory system.
When directly or indirectly caused by increased pulmonary blood pressure, pulmonary edema may appear when this pressure increases from the normal 15 mmHg[3] to above 25 mmHg
Symptoms of Pulmonary edema
Breathing difficulty
Shortness of breath
Shallow breathing
Rapid breathing
Shortness of breath worse on lying down
Wheezing
Cyanosis
Anxiety
Restlessness
Cough
Dry cough
Pink-stained sputum cough
Bubbling sounds when breathing
Weak pulse
Pounding pulse
Lung crackling sounds (rales) in stethoscope
Swollen hands
Swollen ankles
Hypotension
Enlarged veins
Exams and Tests
The health care provider will perform a physical exam and use a stethoscope to listen to the lungs and heart. The following may be detected
:
* Crackles in the lungs, called rales
* Abnormal heart sounds
* Increased heart rate (tachycardia)
* Pale or blue skin color (pallor or cyanosis)
* Rapid breathing (tachypnea)
Possible tests include:
1. Complete blood count (CBC) to check for anemia and reduced red cell count
2. Other blood tests to measure blood chemistries and kidney function
3. Blood oxygen levels (oximetry or arterial blood gases) -- low in patients with pulmonary edema
4. Chest x-ray may reveal fluid in or around the lung space or an enlarged heart
5. Electrocardiogram (ECG) to detect abnormal heart rhythm or evidence of a heart attack
6. Ultrasound of the heart (echocardiogram) to see if there is a weak heart muscle, leaky or narrow heart valves, or fluid surrounding the heart
What is the treatment for pulmonary edema?
The treatment of pulmonary edema largely depends on its cause and severity.
Most cases of cardiac pulmonary edema are treated by using diuretics (water pills) along with other medications for heart failure. In the majority of situations, appropriate treatment can be achieved as an outpatient by taking oral medications. If the pulmonary edema is more severe or it is not responsive to oral medications, then hospitalization and the use of intravenous diuretic medications may be necessary.
The treatment for noncardiac causes of pulmonary edema varies depending on the cause. For example, severe infection (sepsis) needs to treated with antibiotics and other supportive measures, or kidney failure needs to be properly evaluated and managed.
Oxygen supplementation is sometimes necessary if the measured oxygen level in the blood is too low. In serious conditions, such as ARDS, placing a patient on an artificial breathing machine is necessary to support their breathing while other measures are taken to treat
pulmonary edema and its underlying cause.
الخميس أبريل 22, 2010 8:19 pm
