Treatment of pulmonary edema with heart failure
Pulmonary edema on the background of left ventricular failure or mitral stenosis is described in Ch. " PULMONARY EDEMA ". This is a life threatening condition requiring emergency treatment.
As in chronic heart failure. First of all, it is necessary to identify and eliminate provoking factors, in particular, arrhythmias and infection. If time permits, it is desirable to install a Swan-Ganz catheter to monitor pulmonary arterial pressure and DZLA and an arterial catheter for direct BP measurement. To delay with treatment, however, it is impossible: all the following measures are carried out almost simultaneously:
- Assign morphine. 2-5 mg IV, if necessary repeatedly. This drug reduces anxiety and has a vasodilating effect (due to a decrease in sympathetic tone). In the case of respiratory depression, keep naloxone ready.
- Give 100% oxygen, preferably under pressure,since at alveolar edema of the lungs diffusion of oxygen is violated and hypoxemia arises. Increased pressure in the airways is transferred to the alveoli and reduces the yield of liquids from the capillaries. In addition, it complicates the venous return to the organs of the chest cavity, which reduces the pressure in the pulmonary capillaries.
- The patient is seated, if possible, with his legs down, in order to reduce the venous return.
- Intravenous injected loop diuretics. such as furosemide. ethacrynic acid (40-100 mg) or bumetanide (1 mg) to achieve rapid diuresis and reduce BCC. In addition, furosemide with intravenous administration has a vasodilating effect. reduces venous return and can improve the condition even before the onset of diuretic action.
- If the systolic blood pressure is not lower than 100 mm Hg. Art. iv injected sodium nitroprusside (starting at 20-30 μg / min) to reduce afterload.
- If the measures described above are ineffective, rubber bands are put on the limbs, periodically releasing one of them.
After cupping of the pulmonary edema and eliminationprovoking its factors, it is necessary to address the identification of the underlying disease, if it is not yet diagnosed. Then a permanent treatment is prescribed to prevent repeated pulmonary edema. Sometimes a cardiosurgery operation may be required.