The first thing I should explain is just what is pulmonary edema? In short, it’s nothing more than fluid in the lungs due to congestive heart failure. The word pulmonary refers to lungs and edema is a fancy way of saying engorged vessels. These types of patients are typically overweight and are often found with other problems that include Chronic Obstructive Pulmonary Disease (C.O.P.D.) and Bronchitis.
So let us now look at how to identify a patient with Pulmonary Edema. The signs and symptoms are:
– Noisy (audible) bronchi
– Listen for rales, ronchi
– Possible 1 to 2 word dyspnoea
– Altered mental status
– Patients are ALWAYS sitting up
– Frothy sputum with a pink hinge
– Distended abdomen
– Severe hypoxia (in spite of nonrebreather mask with O2 @ 15 lpm)
– Cyanotic (O2 levels ALWAYS below 90%)
– Skin is wet (in dependent areas – always note where dampness is located)
– If it’s the arms and legs it is called Pitted Edema
– Wetness on the buttocks is called Sacral Edema
– Patient will be cool to the touch
– Tachycardia
– Questionably patent airway
Upon assessment u should perform a skin pinch test to test for skin turgor to check for dehydration. Note if the patient’s skin remains upright 3+ seconds after letting loose your fingers. This is called tenting and should be documented. If you push in on the skin and it takes 3 seconds or more to return back to normal position then this is called 3+ Edema, 4+ Edema, etc.
So what prehospital treatment will these patients receive? The first thing the patient will receive is O2 @ 15 lpm to start out (NO NASAL CANNULA!!!), and transport to the hospital. An option you have if the patient is responsive is to use a nebulizer, but should be used with caution. The medication used with the nebulizer is Albuteral; or epinephrin. This medication is a vaso constrictor and bronchi dilator. Should the patient be unresponsive then you will need to suction. May use a combitube to help suction if needed. If the unit is A.L.S. then the paramedic may choose to use Lasix (Furosemide) to increase the urine output so as to reduce the fluid in the body.