Acute pulmonary edema

　　1. Acute diffuse myocardial damage leading to weakened myocardial contractility, such as acute extensive myocardial infarction, acute myocarditis, etc.

　　2. Acute mechanical obstruction causing increased cardiac pressure overload and blood ejection obstruction, such as severe hypertension, aortic valve stenosis, or mitral valve stenosis, etc.

　　3. Acute cardiac overload, such as valvular damage, chordae tendineae rupture, papillary muscle dysfunction, ventricular septal perforation, etc., caused by acute myocardial infarction or infectious endocarditis, heart injury, etc.; In addition, excessive and rapid intravenous blood transfusion and fluid infusion may also lead to acute pulmonary edema.

　　4. Acute ventricular diastolic restriction, such as reduced cardiac output and systemic congestion caused by acute cardiac tamponade due to acute large amounts of pericardial effusion; ⑤Increased tissue metabolism and accelerated circulation, such as hyperthyroidism, severe anemia, etc.

　　Acute pulmonary edema may complicate with DIC, acid-base imbalance, damage to various organs and systems, eventually leading to multiple organ failure.

　　1. Interstitial edema phase

　　Symptoms: The patient often feels chest tightness, fear, cough, and difficulty breathing.

　　Signs: Pale complexion, rapid breathing, tachycardia, elevated blood pressure, wheezing may be heard.

　　2. Alveolar edema phase

　　Symptoms: The patient's face becomes paler, they feel more short of breath, and they may sweat coldly.

　　Signs: cyanosis of the lips and nail beds, a large amount of pink frothy sputum, patients under general anesthesia may show increased respiratory resistance and cyanosis, a large amount of pink frothy sputum is expelled through the tracheal tube; bilateral lung auscultation: full lung moist rales, blood pressure drop.

　　1. Control the infusion rate and type of infusion:Rapid infusion rate and excessive crystalloid fluid administration are the most common causes of pulmonary edema during anesthesia, especially in the elderly, infants and young children, and patients with poor cardiac function. Intraoperative central venous pressure monitoring is used to guide fluid and blood transfusion.

　　2. Clearing the airway and respiratory support:Maintain an unobstructed airway, prevent excessive respiratory secretions, vomiting, reflux, and aspiration to avoid airway obstruction and laryngospasm and bronchospasm.

　　1. X-ray examination:Pulmonary interstitial edema stage: pulmonary vascular markings are blurred, and the hilum shadow is unclear. The interlobular septum is widened, forming Kerley A and B lines. Pulmonary alveolar edema stage: mainly pulmonary alveolar dense shadows, merging into irregularly shaped blurred shadows, diffused distribution or localized to one side or lobe, or seen at both sides of the hilum, fading outwards gradually, forming the so-called butterfly-shaped typical.

　　2. Blood gas analysis:Intermediate stage of pulmonary interstitial edema: PaCO2 is low, pH↑, presenting as respiratory alkalosis. Pulmonary alveolar edema stage: PaCO2 is high and/or PaO2 decreases, pH is low, presenting as hypoxemia and respiratory acidosis.

　　Eat high-sugar foods as much as possible, adjust the structure to be the first carbohydrate, the second fat, and the third protein. If possible, consume more liquid energy, such as fruit juice, soup, milk, and they can also supplement some water. Milk tea is a good food, as is butter tea, which is a high-calorie food with a lot of fat, which has a protective and moisturizing effect on the skin. The theophylline inside also has a diuretic effect.

　　1. Maintain the airway, provide sufficient oxygen and mechanical ventilation treatment, and correct hypoxemia.

　　2. Reduce pulmonary vascular hydrostatic pressure, increase plasma colloid osmotic pressure, and improve pulmonary capillary permeability.

　　3. Keep the patient calm and prevent and control infection. The patient should be in a sitting position with the legs dangling.