In the high-stakes world of emergency medicine, respiratory diseases pose a serious threat. Diseases such as pulmonary oedema pose a serious health threat, as it requires immediate emergency care and may be the result of underlying and undiagnosed diseases. For medical personnel, this poses an incredible risk to the patient’s life, it requires prompt and precise intervention. In this article, we delve into exploring the pathophysiology of pulmonary oedema, as well as the clinical manifestations and treatment options to consider for the best patient outcome. By equipping yourselves with the above knowledge, we can all provide valuable patient care and can be the vital link to instilling assurance for survival.
Pathophysiology:
The most common cause of pulmonary oedema is a result of heart failure. Heart failure occurs when the hearts’ ability to pump blood is compromised and blood is not circulating throughout the body efficiently. As a result of this, the blood is backed up within the pulmonary circuit, increasing hydrostatic pressure. When hydrostatic pressure is increased, the capillaries of the pulmonary leak due to the pressure exceeding oncotic pressure (pressure that keeps fluid within the blood vessels), this imbalance results in fluid leaking into the interstitial spaces in the lungs. The fluid that is in the interstitial space moves to the alveoli over time, impairing gas exchange. The body in turn activates mechanisms to counteract the damage impairment that oedema is causing by increasing heart rate and respiratory rate, however, this may cause even more strain on the heart which is already compromised.
Signs and Symptoms:
The signs and symptoms of pulmonary oedema will vary from patient to patient, it should also be noted that these manifestations may overlap with other signs of respiratory and cardiac conditions that are causing the fluid to develop.
- Dyspnoea (shortness of breath)
- Cough
- Tachypnoea (rapid breathing)
- Restlessness/anxiety
- Wheezing
- Cyanosis
- Orthopnoea
During an auscultation of a patient suffering from pulmonary oedema, crackles can be heard at the bases of the lungs, indicating the presence of fluid in the alveoli or interstitial space. A high-pitched wheezing sound can also be heard as air travels through a narrowed airway because of the fluid build-up.
Treatment:
For a patient discovered to be suffering from pulmonary oedema, it is best to manage all vitals and not only focus on the discovered disease but also investigate the underlying cause of the fluid and treat it as presented. If your patient is having trouble breathing, administer supplementary oxygen, through a bag-valve-mask ventilator or whichever advanced airway management technique is required to stabilise the patient's respiratory. Next, consider IV access and administration of diuretic medications to promote diuresis and remove the fluid. Vasodilators may even need to be considered, to reduce the workload of the heart, if heart failure has been discovered during the primary or secondary survey. The patient's vitals, such as ECG and oxygen saturation must consistently be monitored, as these tools will typically be the first things to change if the patient experiences any abnormalities with their condition. It is essential to provide swift and precise care to the patient and use the best clinical judgement to initiate the best care.
As frontline medical workers, the journey towards the mastery of medical knowledge is a long path, but through breaking down the information required for pathophysiology, clinical manifestations and treatment for each condition, the learning journey gets easier and easier. Pulmonary oedema is a must-know for clinicians and through further learning and practice, patient management becomes easier and more manageable, all in all, resulting in better patient outcomes.
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