1. Dr MH Soltani cardiologist

2.  Pulmonary edema is a condition characterized by fluid accumulation in the lungs caused by back pressure in the lung veins. This results from malfunctioning of the heart.

3.  Fluid backs up into the veins of the lungs. Increased pressure in these veins forces fluid out of the vein and into the air spaces (alveoli). This interferes with the exchange of oxygen and carbon dioxide in the alveoli.

4.  Edema occurs when physiologic resorption of fluid via lymphatic's is overwhelmed  Causes usually divided into “hydrostatic” and “increased capillary permeability”, but both mechanisms can occur in the same patient!  Chest radiography, when combined with clinical data, helps distinguish pathologic cause in vast majority of cases

6. Normally, excess hydrostatic transudate from pulmonary capillaries is filtered into peribronchovascular lymphatics and removed

7.  In hydrostatic edema, transudate accumulates in the interstitium initially, only entering alveoli in severe cases  In permeability edema associated with diffuse alveolar damage (DAD), exudate fills the interstitium and the alveoli

8.  The lungs can accommodate increases in fluid: the lymphatic flow can increase 3- 10x before edema develops  Higher hydrostatic pressures force fluid through endothelial cell pores, but the tighter junctions of epithelial cells prevent fluid from entering alveoli until pulmonary capillary pressures reach ~ 40 mm Hg, causing stress failure

9.  Pulmonary edema is a complication of a myocardial infarction (heart attack), mitral or aortic valve disease, cardiomyopathy, or other disorders characterized by cardiac dysfunction.

11.  Extreme shortness of breath, severe difficult breathing  Feeling of "air hunger" or "drowning"  "Grunting" sounds with breathing  Inability to lie down  Rales  Wheezing  Anxiety

12.  Restlessness  Cough  Excessive sweating  Pale skin  Nasal flaring  Coughing up blood  Breathing, absent temporarily

13.  Listening to the chest with a stethoscope (auscultation) may show crackles in the lungs or abnormal heart sounds.  A chest x-ray may show fluid in the lung space.  An echocardiogram may be performed in addition to (or instead of) a chest x-ray.

14.  Blood oxygen levels (low)  A chest X-ray may reveal the following:chest X-ray  Fluid in or around the lung space  Enlarged heart

22.  An ultrasound of the heart (echocardiogram) may reveal the following:  Weak heart muscle  Leaking or narrow heart valves  Fluid surrounding the heart

23.  L asix IV (high dose if pt. prev. on it)  M orphine (at least 4mg IV to start)  N itroglycerin (SL, paste, or drip)  O xygen (100% NRBM, then PAP)  P ositive pressure ventilation (noninvasive bilevel positive airway pressure “BiPAP™” or intubation)

24. NASAL CANNULA. The nasal cannula, or nasal prongs, is used at flow rates of 1 to 6 L/min. Approxi­mate oxygen concentrations of 24% (at 1 L/min) to 44% (at 6 L/min) can be achieved.

25. SIMPLE FACE MASK. A simple face mask is used to deliver oxygen concentrations of 40% to 60% for short- term oxygen therapy or in an emergency. A mini­mum flow rate of 5 L/min is needed to prevent the rebreathing of exhaled air.

26. PARTIAL REBREATHER MASK. A partial rebreather mask provides oxygen concentrations of 60% to 75%, with flow rates of 6 to 11 L/min.

27. NON-REBREATHER MASK. A non-rebreather mask provides the highest concentration of the low-flow systems and can deliver an Fio 2 greater than 90%,