Pulmonary edema

Pulmonary edema-What is pulmonary edema?

Pulmonary edema, the lungs function of fluid exchange between the blood vessels and tissue disorder caused by increased lung water content. Pulmonary edema can severely affect the respiratory function, is clinically more common cause of acute respiratory failure. Main clinical manifestations of extreme dyspnea, orthopnea, cyanosis, sweating, paroxysmal cough with white or pink frothy sputum, lungs full of symmetry auscultation, X-ray shows lungs butterfly sheet fuzzy shadow, late shock and even death. Arterial blood gas analysis early low of O2, low CO2 partial pressure, a serious shortage of O2, CO2 retention and mixed acidosis.

Pulmonary edema - therapeutic mechanismPressure and lung tissue alveolar pulmonary edema hyperbaric oxygen pressure over the capillary hydrostatic pressure to stop capillary oozing; high pressure allows the respiratory tract, the bubble volume is reduced or broken, respiratory become clear.
Hyperbaric oxygen, oxygen content, alveolar oxygen partial pressure and pulmonary capillary oxygen difference increased oxygen diffusion from the alveoli into the blood, the amount of a corresponding increase to correct the hypoxic state of the heart, brain, kidney and other vital organs to prevent the acute phase of pulmonary edema and death due to lack of oxygen.
Diagnosis is based on:Interstitial pulmonary edema. Markings and hilar shadow edges are fuzzy. Pulmonary blood flow redistribution phenomenon, that is, by the normal pulmonary vascular pulmonary vascular fine into the lung field vascular thickening. Bronchial cuff levy, bronchial axis projection visible wall ring thickness broadening, edge blur, and called cuff levy. 4 interval line of shadow, the pathological basis is interlobular septal edema. Can be divided into KerleyA, B, C, line, line B is the most common length is less than 2cm, and pleural vertical. Subpleural edema, similar to pleural thickening, does not change with body position changes. Interlobar pleural thickening and edema of the interlobar fissure. (6) is often associated with increased heart shadow. A small amount of pleural effusion.
Alveolar pulmonary edema. Alveolar consolidation in the shadow of early nodular shadow, about 0.5-1cm size, edge blur, and soon fused into patches or large patchy shadows with pulmonary edema gas bronchial image density is uniform. (2) the distribution and morphology of the diversity was central, diffuse and localized. The central performance is symmetrically distributed within the band in the lungs patchy shadows in the higher density of hilar area, shaped like a Butterfly called Butterfly levy. Localized visible on the side of a leaf, more common on the right. In addition to the patchy shadows, but also was one or a few large round shadow, outline clearly resembles the tumor. (3) dynamic changes: pulmonary edema initially occurred in the lung the lower part of the inside and rear, and soon the upper to the lung, lateral and anterior development, the lesions often change significantly within a few hours. Pleural effusion: the more common, more than a small amount of effusion was bilateral. 5 increased heart shadow.
Renal pulmonary edema in addition to the above-mentioned image features, but also showed the following characteristics: 1. The shadow of the pulmonary vascular ordinary thickening. (2) vascular pedicle widened. Three diffuse distribution: found in chronic nephritis with uremia. Lung field with more shadow.
Dogs, cats, pulmonary edemaSymptomA. Sick dogs, cats, sudden onset of head and neck stretch, nose flap, shortness of breath or difficulty breathing, or mouth breathing, respiratory rate increased significantly, up to 60 to 80 times more per minute.Two. Sick dogs, cats frightened surface vein distention, proptosis, conjunctival flushing or cyanosis, two nostrils out of the white or pink nasal fluid contains a large number of small bubble.3. Chest auscultation can hear extensive blisters tone. X-ray lung field shadows deepen the texture of the hilar blood vessels also deepened.
DiagnosisAccording to history, sudden onset of difficulty breathing, white or pink foamy nasal fluid outflow by the two nostrils, and X-ray examination shadows deepen, can be diagnosed.

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Pulmonary edema - first aid treatment
Pulmonary edema and first aid points are: to keep quiet, to reduce the burden on the heart to stop oozing and ease breathing difficulties.

A. The first animal quiet, available sedatives, such as per kilogram body weight injected morphine sulfate 0.5 to 1 mg, bitartrate, hydrocortisone 1 to 2 mg, 2 to 4 mg or barbiturates 5 to 15 mg of pentobarbital.

Two. Due to acute left ventricular insufficiency due to pulmonary edema, epinephrine, isoproterenol, and other available bronchodilators. Intravenous aminophylline 10 mg per kilogram of body weight, relieve bronchospasm, bronchial expansion effect is better. Should be to ease breathing difficulties caused by hypoxia, oxygen per minute, 5 to 6 liters speed input oxygen through the nose. Reduce the venous return flow, can be venous blood, and put the blood for 6 to 8 ml per kilogram of body weight.

3. Cardiac diuretic, available Cedilanid, each 0.5 to 0.6 mg dog, cats, each 0.2 to 0.3 mg, intravenous or intramuscular injection after 6 hours halve the amount of re-injection. 2 to 4 mg per kilogram of body weight oral furosemide, 2 or 3 times a day, or hydrochlorothiazide dogs each from 0.025 to 0.1 grams a day, 1 or 2 times. With high concentrations of glucose solution or dextran solution have a significant diuretic effect.

4. To stop oozing, atropine, hydrocortisone, intramuscular, intravenous calcium gluconate.

5 Concurrent bacterial infection, systemic antibiotics or sulfa drugs, or twitter promise ketones antimicrobial agents

 

Pulmonary edema - high altitude pulmonary edema
Pulmonary edema, high altitude pulmonary edema is a recently arrived in the plateau (usually at 3000 meters above sea level), the emergence of resting dyspnea, chest tightness tamponade flu, cough, cough white or pink frothy sputum, patients with a sense of malaise or activity reduced.

Prevention
Into the plateau to know more about the climate characteristics of the plateau, to learn more about the knowledge of altitude sickness to eliminate the fear of the high altitude environment;
2, enter the plateau, you must be a strict health checks;
3, keep warm, to prevent exposure to cold.
4, the beginning of the plateau within a week to rest and gradually increase activity levels, reduce and avoid strenuous exercise to avoid fatigue;
5, suffering from high altitude pulmonary edema is easy to relapses;
6, drug prevention: the plateau rather, Rhodiola capsules.

Pulmonary edema treatment
Dying weight, such as the emergence of resting dyspnea, cough, cough, white or pink frothy sputum recommendations to a local hospital immediately for treatment.

Signs and symptoms
The incidence is more common in areas above an altitude of 3000m. Initial entry or return to the high altitude, the onset into the plateau within 7 days, and flew into the plateau incidence among those in the 3d. Symptoms include headache, difficulty breathing, not supine, slightly white or pink frothy sputum, check see cyanosis or looking Tuhui, to, lungs large, medium moist rales, and sputum.

Lung edema disease due to
Inquiry should note the following: Status: ① contact plateau is the initial access to the plateau or return to the plains to return to the plateau, after a period of residence or to enter the plateau from the plateau to another higher up; ② The incidence of the altitude of the region; ③ elapsed time of onset; ④ The incidence without significant incentives, such as climb speed is too fast, too much physical activity, cold or climate change, hunger, fatigue, insomnia, motion sickness, emotional stress, upper respiratory tract infection and other factors; ⑤ disease after (below 3001m) without oxygen or transferred to a low condition of natural improvement in history; ⑥ The enter the plateau before or before the onset of any similar onset of symptoms

 

Pulmonary edema - diagnostic tests

One should pay attention to early diagnosis. On the basis of acute mountain sickness or the flu and other incentives, and one of the following conditions should consider the possibility of the disease: ① dyspnea, cyanosis, accompanied array cough, spit up mucous or serous frothy sputum. ② night due to paroxysmal dyspnea arousal, irritability, array cough and sputum. Significantly faster ③ heart rate, heart sounds, P2, hyperthyroidism, or split, precordial the systolic hair murmur grade Ⅱ, occasional gallop. Lung auscultation with scattered rales or crepitation.
Lung X-ray findings than clinical signs appear as early diagnostic value. Lung field transmittance degree weakened and scattered sheet or flocculent fuzzy shadow, near hilar Department, more significant formation of Butterfly-shaped; lesions were localized or both sides of the lung field asymmetry; heavy floc shadow high concentrations, a wide range of integration into the cotton lumps.
Laboratory tests according to the condition of blood, urine, serum electrolytes and blood gas analysis, liver and renal function, electrocardiogram and other tests.
(4) with bronchial asthma and other reasons caused by pulmonary edema identification. Such as cardiogenic pulmonary edema caused by a variety of structural heart disease, lung infections caused by pulmonary edema, and other physical and chemical factors-induced permeability pulmonary edema.
5 duration of attention to whether pulmonary infection, and observe whether the shock, heart failure, early coma, pulmonary embolism and other complications

 

Pulmonary edema - treatment options
Emphasis on early detection, early diagnosis, to take place the principle of treatment. Absolute bed rest, take slope supine.
(2) oxygen treatment and rescue measures. Severe cases should be a high concentration (~ 8L/min) pressurized oxygen. Where available, treatment with hyperbaric oxygen chamber.
(3) reduce pulmonary artery pressure is an important part of treatment. Available aminophylline 0.25, slow intravenous glucose solution 20ml, 4 ~ 6h can be repeated. Or phentolamine 5mg slow intravenous glucose solution 20mi, 1 ~ 2 / d, can also be used 10 ~ 20mg, joining 250 ~ 500ml of 5% glucose solution intravenously.
(4) reduction of pulmonary blood volume available dehydrating agent or diuretics, 20% mannitol 250ml intravenous infusion, or furosemide (furosemide) 20 mg intravenous injection of 1 ~ 2 / d.
5 available glucocorticoids reduce pulmonary capillary permeability, such as hydrogenated glucose loose 200 ~ 300mg 250 ~ 500ml intravenous infusion of 1 / d. Or dexamethasone 10 mg intravenously, intravenous or intramuscular injection, 1 ~ 2 / d. Intravenous infusion of large doses of vitamin C (3 ~ 5g) can also be applied.
Morphine can be used for sitting breathing, irritability, cough, pink or bloody frothy sputum of critically ill patients. 5 ~ 10mg intramuscular or subcutaneous injection, if necessary, to 5mg diluted with normal saline 10ml slow (5min) IV. But not for respiratory function suppression as well as drowsiness, coma. Nausea and vomiting and other reactions can not tolerate morphine, or accompanied by bronchospasm, can be used pethidine 50 to 100mg intramuscular injection.
For the prevention and control of respiratory tract infection, should the application of effective antibiotic treatment.
Application of other measures to soak agent (ethanol or dimethyl silicone) 654-2 -2 intramuscular, or nifedipine or isosorbide mononitrate) (isosorbide dinitrate) sublingual isosorbide mononitrate (isosorbide dinitrate ) aerosol.
With heart failure, shock, coma should be given to the appropriate processing.
10 In view of the long-distance forwarding treatment adverse, you must follow on control to the following principles: ① The local do not have medical conditions and rescue short-term hard to reach; ② short journey, delivery conditions, may reach 1 ~ 2h; ③ local rescue in stable condition medical personnel to accompany; forwarding on the way should not interrupt the treatment.

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