ACUTE PULMONARY EDEMA

Guenther von Eye, MD,Cardiology. Associate Professor of Internal Medicine, Rio Grande do Sul State University Medical School (UFRGS).

Acute pulmonary edema is a severe clinical condition, associated to great suffering, with a feeling of imminent death, which requires immediate medical attention.

Causes of acute pulmonary edema:
 

Myocardial infarction- is the most common cause
Cardiac muscle dysfunction
Disorders in the valves, aortic or pulmonary
Fluid overload, usual in infants.

The heart is divided into four parts (chambers) responsible for blood entrance into the heart, and an atrium and ventricle on the right, an atrium and ventricle on the left, responsible for blood exit from the heart.

In left-side heart failure, there's an accumulation of blood in the pulmonary veins until a point when the fluids leak into the air spaces of the lungs. This renders the lung less elastic and with smaller contact surface between the gases inhaled and the blood.

Prevention of acute pulmonary edema

In most cases, it's not possible to prevent the acute edema.

Risks can be decreased by prompt treatment and suitable management of the disorders that may lead to the acute edema.

Signs and symptoms of acute edema:
 

Shortness of breath with severe respiratory difficulty.
Air hunger
Stertorous breathing; one can hear the crackles in the lung.
Orthopnea – the patient is impelled to sit up, he/she cannot remain lying down.
Nasal flaring (occasionally)
Bloody and frothy sputum (occasionally)
A chest radiograph can show the accumulation of fluids in the lung.

Treatment

Acute pulmonary edema is a medical emergency and requires:
 

Immediate treatment
Transfer to an emergency service or emergency unit in a hospital.

Where possible, oxygen should be administered through a face mask or tracheal intubation.

A tourniquet can be alternately applied around the arms or legs while awaiting specialized treatment.

We can use Furosemide intravenously (where impossible to have venous access, medication can be administered intramuscularly) in order to force fluid elimination and morphine to alleviate pulmonary congestion and anxiety. The additional medications used are aimed at treating the underlying disorders of the acute edema. This should be done by a doctor in a hospital environment, preferentially.

As acute pulmonary edema is a medical emergency, the priority at the moment of assistance is the administration of drugs and accomplishment of measures that alleviate the heart efforts. Transfer to a suitable place is the second priority.

Be prepared for emergencies!

Always keep the phone numbers of the emergency services and of your doctor on hand, where you can easily find them.

 

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