Pulmonary edema - description, causes, treatment. Pulmonary edema, acute left ventricular failure Why do you need to code the disease?

Modern world conceals many diseases that a person may encounter, their forms, course and distribution are so diverse that for effectiveness medical practice it was decided to create unified system classification of diseases that can be used throughout the world. Such a system was ICD-10, the international classification of diseases, which is updated by WHO once every ten years.

The classifier allows you to use a unified system for treating certain diseases, as well as analyze the level of mortality, injuries or spread of the disease.

According to ICD-10, pulmonary edema is assigned the code J81 - pulmonary congestion or acute pulmonary edema included in respiratory diseases.

ICD coding and its features

The latest revision of the disease classifier included alphabetical gradation in the digital numbering system. This made it possible to expand the classification and deepen it without violating the list of main diseases.

The latest system is considered complete and finalized, it includes:

a complete list of diagnoses, conditions, injuries and other reasons for seeing a doctor - consists of
three-digit headings and four-digit sub-headings;
a list of major diseases for maintaining statistics of mortality and morbidity of the population;
coding of the causes of neoplasms;
factors influencing human health;
list of exceptions;
table medicines And chemical substances.

For example, you can study pulmonary edema, which is numbered J81. It is included in the class “respiratory diseases”, in the block “Other respiratory diseases affecting mainly interstitial tissue”. The classification immediately excludes hypostatic pneumonia and offers three more specific cases of the disease:

condition caused by inhalation of chemicals, vapors or gases - chemical edema (J68.1);
caused by external substances - organic and inorganic dust, solid or liquid substances, radiation, toxic substances or drugs (J60-J70);
Left-sided heart failure without other indications can provoke pulmonary edema, often this condition leads to myocardial infarction, but stagnation of blood in the lungs and capillary resistance leads to alveolar dysfunction (I50.1).

Varieties of pulmonary edema have similar symptoms:

cough;
difficulty breathing;
sitting position with emphasis on hands;
inability to breathe deeply;
pale and cold skin;
suffocation.

Why do you need to code a disease?

For the health system to operate effectively, it is necessary constant development and improving the quality of treatment, as well as developing new directions in the field of medicine and pharmacology. But to identify areas of activity, it is necessary for doctors all over the world to adhere to a single standard treatment system, this will allow them to evaluate effectiveness and develop new methods.

To do this, we created a unified international disease classification system, which will allow us to obtain the following indicators around the world:

morbidity statistics around the world, identification of population groups prone to different types diseases,
as well as the definition of epidemics;
indicators on the mortality rate, establishing the causes of mortality, which makes it possible to develop
measures to reduce the indicator;
the cause-and-effect relationships of diseases are assessed;
storage of data on epidemics, morbidity and mortality rates over recent years;
standard offered efficient scheme treatment taking into account the determination of the morphology of the disease.

All this data allows international healthcare to carry out preventive measures, including various groups population, formulate clear requirements for pharmaceutical companies, introduce new treatment methods as quickly as possible.

Thanks to this system, anywhere in the world, if a patient develops pulmonary edema, the doctor will apply emergency treatment, which includes a mask with 100% oxygen, possible intubation with positive expiratory pressure, administration of furosemide, morphine and cardiac drugs in case of a cardiac factor.

The doctor enters the information received into the patient’s record, which also indicates the effectiveness of treatment and possible complications. Data becomes part of the statistical indicators needed for health development.

With its help, the unity and comparability of health care materials in all countries is maintained. This classification allows you to keep track of global diseases, for example, tuberculosis or HIV. Pulmonary edema according to ICD 10 is encrypted with certain letters and numbers, like other pathologies.

Encoding Features

Acute pulmonary edema is located in class X, which includes all respiratory diseases. Direct the pathology code is J81. However, some varieties of this complication are present in other classes and sections.

The ICD 10 code for pulmonary edema can be I50.1. This happens in cases where it is caused by cardiac left ventricular failure. Fluid accumulation is caused by many chronic pathologies heart, but most often myocardial infarction. For its formation, two main criteria are needed: stagnation of blood in the lungs and an increase in capillary resistance.

This type of edema is also called cardiogenic, cardiac asthma, or left-sided heart failure. . It is important to distinguish cardiogenic swelling from other types according to ICD 10, since it is this type that most often ends in the death of the patient.

Much less often, according to ICD 10, pulmonary edema is coded as follows:

J18.2 - occurs due to hypostatic pneumonia;
J168.1 - pulmonary edema of a chemical nature;
J160-170 - the development of swelling is caused by exposure to external agents (certain dust, gases, smoke, etc.).

Why do you need to code a diagnosis?

Many are perplexed as to why code pulmonary edema according to the ICD. Moreover, each individual case may have a different designation in the classification. For treatment pathological process or to eliminate its complications, it is rarely needed. However, the ICD has a large number of important areas of application. With her help:

maintain statistics of morbidity and mortality of the population (both global and individual population groups);
conveniently store healthcare data;
assess the situation in the field of epidemiology;
the relationships between pathology and certain factors are analyzed;
The management of global health is simplified.

In addition to the main functions, there are many more highly specialized areas in which the ICD is used. For example, development preventive measures, drawing up treatment protocols, and so on. Therefore the code for pulmonary edema allows data on this deadly complication to be stored and used worldwide.

Before assigning the appropriate coding, the doctor must take into account all the factors of the pathology that allow it to be assigned to one or another section.

When pathology is detected, the most important thing is to establish the connection between the complication and heart disease. This gives reason not only to change the pathology code, but also to assign it to a completely different ICD class.

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RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical protocols Ministry of Health of the Republic of Kazakhstan - 2007 (Order No. 764)

Left ventricular failure (I50.1)

general information

Short description

Acute left ventricular failure(ALFN) and its main manifestations, cardiac asthma and pulmonary edema - represent pathological condition, caused by abundant sweating of the liquid part of the blood into the interstitial tissue of the lungs, and then into the alveoli, which is clinically manifested by severe suffocation, cyanosis and bubbling breathing.

Protocol code: E-014 "Pulmonary edema, acute left ventricular failure"
Profile: emergency

Purpose of the stage: restoration of the function of all vital systems and organs.

ICD-10 code(s): I50.1 Left ventricular failure

Classification

1. Stagnant type: left ventricular acute heart failure (cardiac asthma, pulmonary edema); right ventricular acute heart failure (venous congestion in big circle blood circulation).

2. Hypokinetic type: cardiogenic shock.

Risk factors and groups

Age over 60 years;

Repeated myocardial infarction and asthmatic variant of its development;

A history of circulatory disorders, obesity, chronic diseases, frequent attacks of angina pectoris before the occurrence of myocardial infarction.

Diagnostics

Diagnostic criteria

In acute left ventricular heart failure:

Sudden onset with feeling of shortness of breath;

Increasing shortness of breath of varying severity, often turning into suffocation;

Sometimes Cheyne-Stokes breathing (alternating short periods of hyperventilation with pauses in breathing);

Cough (at first dry, and then with sputum), later - foamy sputum, often colored pink;

Forced position of the patient sitting or half-sitting (orthopnea);

The patient is excited, restless;

Paleness and increased moisture of the skin (“cold” sweat), cyanotic mucous membranes;

Tachycardia (up to 120-150 per minute), protodiastolic gallop rhythm;

Swelling of the neck veins;

Normal or reduced levels blood pressure;

Moist rales may not be heard at first, or a meager amount of fine bubbling rales is detected over the lower parts of the lungs; swelling of the mucous membrane of the small bronchi can manifest itself as a moderate picture of bronchial obstruction with prolongation of exhalation, dry wheezing and signs of pulmonary emphysema;

With alveolar pulmonary edema (pulmonary edema syndrome) - ringing moist rales of various sizes over all the lungs, which can be heard at a distance (bubbling breathing);

Percussion: moderate shift to the left of the border of relative cardiac dullness (dilatation of the left ventricle).

List of main diagnostic measures:

1. Determination of the onset of development of shortness of breath and the nature of its behavior (sudden appearance or gradual increase); as well as the conditions for the occurrence of shortness of breath (at rest or physical activity).

2. Establishment of symptoms preceding the present condition (chest pain, episode hypertensive crisis).

3. Establishment medicines taken by the patient and their effectiveness.

4. Clarification of medical history (recent myocardial infarction, episode of congestive heart failure).

5. Evaluation general condition and vital important functions: consciousness, breathing, blood circulation.

6. Patient position: orthopnea.

7. Visual assessment: skin (pale, high humidity), the presence of acrocyanosis, swelling of the neck veins and veins of the upper half of the body, peripheral edema ( lower limbs, ascites).

8. Assess the frequency of respiratory movements (tachypnea), pulse (tachycardia or rarely bradycardia).

9. Blood pressure measurement: decrease in SBP below 90 mmHg. Art. - sign of shock; hypotension (with severe myocardial damage); or hypertension (during the body’s stress response).

10. Percussion: the presence of an increase in the boundaries of relative dullness of the heart to the left or right (cardiomegaly).

11. Palpation: displacement of the apex beat and the presence of an enlarged, painful liver.

12. Auscultation of the heart: protodiastolic or presystolic gallop rhythm, systolic murmur at the apex of the heart.

13. Auscultation of the lungs: presence of moist rales.

List of additional diagnostic measures

ECG signs of left ventricular acute heart failure:

Bifurcation and increase in the amplitude of the P wave in leads I, II, aVL, V5-6;

An increase in the amplitude and duration of the second negative phase of the P wave or the formation of a negative P wave in leads V1;

Negative or biphasic PIII wave;

Increase in the width of the P wave - more than 0.1 s.

Differential diagnosis

A differential diagnostic sign of acute left ventricular failure with bronchial asthma can be the dissociation between the severity of the condition and (in the absence of a pronounced expiratory nature of shortness of breath and “silent zones”) the paucity of the auscultatory picture.

With alveolar pulmonary edema, loud, varied moist rales are detected over all the lungs, which can be heard at a distance (bubbling breathing).

For shortness of breath, differential diagnosis is carried out with:

Spontaneous pneumothorax (shortness of breath combined with pain);

Central dyspnea (intracranial process);

Psychogenic shortness of breath (tachypnea);

An attack of angina.

Treatment abroad

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Treatment

Tactics of rendering emergency care

Algorithm for providing emergency care for ALV:

1. Vapor inhalation alcohol through a nasal catheter (anti-foaming). Initial rate of oxygen introduction (after 96°C ethanol) 2-3 l/min., for several (up to 10) minutes. When the mucous membranes get used to the irritating effect of the gas, the speed is increased to 9-10 l/min. Inhalation is continued for 30-40 minutes with 10-15 minutes. breaks.

2. Stopping “respiratory panic” narcotic analgesics: morphine 1.0 ml of 1% solution diluted in 20 ml of 0.9% sodium chloride solution and administered intravenously in fractional doses of 4-10 ml (or 2-5 mg) every 5-15 minutes. until elimination pain syndrome and shortness of breath.

3. Heparin 5000 units intravenously.

Points 1-3 are required!

4. When normal blood pressure:

Nitroglycerin sublingually in tablets (0.5-1 mg), or aerosol or spray (0.4-0.8 mg or 1-2 doses), or intravenously 0.1% alcohol solution up to 10 mg in 100 ml of isotonic sodium chloride solution dropwise, increase the rate of administration from 25 mcg/min. until the effect is achieved, under blood pressure control until the effect is achieved;

5. When arterial hypertension:

Sit the patient with lower limbs down;

Nitroglycerin tablets (preferably aerosol) 0.4-0.5 mg sublingually, once;

Furosemide 40-80 mg intravenous bolus;

Nitroglycerin intravenously 0.1% alcohol solution up to 10 mg in 100 ml of isotonic sodium chloride solution dropwise, increasing the rate of administration from 25 mcg/min. until the effect is achieved under the control of blood pressure until the effect is achieved, or sodium nitroprusside 30 mg in 300 ml of 5% dextrose solution intravenously, gradually increasing the rate of infusion of the drug from 0.3 mcg/(kg x min.) until the effect is obtained, while controlling the blood pressure;

Diazepam intravenously in fractional doses until the effect is achieved or a total dose of 10 mg is reached.

6. When moderate hypotension(systolic pressure 75 - 90 mm Hg):

Dopamine 250 mg in 250 ml of isotonic sodium chloride solution, increasing the infusion rate from 5 mcg/(kg x min.) until blood pressure is stabilized at the lowest possible level;

Furosemide 40-80 mg intravenous bolus.

7. When severe arterial hypotension:

Lay the patient down, raising the head of the bed;

Dopamine 200 mg in 400 ml of 5% dextrose solution intravenously, increasing the infusion rate from 5 mcg/(kg x min.) until blood pressure is stabilized at the lowest possible level;

With an increase in blood pressure, accompanied by increasing pulmonary edema, additional nitroglycerin intravenous drip of 1% alcohol solution up to 10 mg in 100 ml of isotonic sodium chloride solution, increase the rate of administration from 25 mcg/min. until the effect is achieved, under blood pressure control until the effect is achieved;

Furosemide 40-80 mg intravenous bolus only after stabilization of blood pressure.

8. Monitoring vital body functions (cardiac monitor, pulse oximeter).

Indications for emergency hospitalization: in case of severe pulmonary edema, hospitalization is possible after its relief or by specialized ambulance teams medical care. The patient is transported in a sitting position.

List of essential medications:

1. *Ethanol 96°C 50 ml, fl.

2. *Oxygen, m 3

3. *Morphine 1% - 1.0 ml, amp.

Information

Sources and literature

Protocols for diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 764 of December 28, 2007)
1. 1.Guide to emergency medical care. Bagnenko S.F., Vertkin A.L., Miroshnichenko A.G., Khabutia M.Sh. GEOTAR-Media, 2006 2. First aid for emergency critical conditions. I.F. Epiphany. St. Petersburg, “Hippocrates”, 2003. 3. Secrets of emergency care. P. E. Parsons, J. P. Wiener-Kronish. Moscow, “MEDpress-inform”, 2006. 4. Guide to intensive care. Ed. A.I. Treshchinsky and F.S. Glumcher. Kyiv, 2004. 5. Internal diseases. The cardiovascular system. G.E. Roitberg. A.V. Strutynsky. Moscow, BINOM, 2003. 6. Order of the Minister of Health of the Republic of Kazakhstan dated December 22, 2004 No. 883 “On approval of the List of essential (vital) medicines.” 7. Order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2005 No. 542 “On introducing amendments and additions to the order of the Ministry of Health of the Republic of Kazakhstan dated December 7, 2004 No. 854 “On approval of the Instructions for the formation of the List of essential (vital) medicines.”

Information

Head of the Department of Ambulance and Emergency Medical Care, Internal Medicine No. 2 of the Kazakh National medical university them. S.D. Asfendiyarova - Doctor of Medical Sciences, Professor Turlanov K.M.

Employees of the Department of Ambulance and Emergency Medical Care, Internal Medicine No. 2 of the Kazakh National Medical University named after. S.D. Asfendiyarova: candidate of medical sciences, associate professor Vodnev V.P.; candidate of medical sciences, associate professor Dyusembayev B.K.; Candidate of Medical Sciences, Associate Professor Akhmetova G.D.; candidate of medical sciences, associate professor Bedelbaeva G.G.; Almukhambetov M.K.; Lozhkin A.A.; Madenov N.N.

Head of the Department of Emergency Medicine of Almaty state institute advanced training for doctors - candidate of medical sciences, associate professor Rakhimbaev R.S.

Employees of the Department of Emergency Medicine of the Almaty State Institute for Advanced Medical Studies: Candidate of Medical Sciences, Associate Professor Silachev Yu.Ya.; Volkova N.V.; Khairulin R.Z.; Sedenko V.A.

Attached files

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Pulmonary edema(OL) - accumulation of fluid in the interstitial tissue and/or alveoli of the lungs as a result of plasma transudation from the vessels of the pulmonary circulation. Pulmonary edema is divided into interstitial and alveolar, which should be considered as two stages of one process. Interstitial pulmonary edema is swelling of the interstitial tissue of the lungs without the release of transudate into the lumen of the alveoli. Clinically manifested by shortness of breath and cough without sputum. As the process progresses, alveolar edema occurs. Alveolar pulmonary edema is characterized by the leakage of blood plasma into the lumen of the alveoli. Patients develop a cough with foamy sputum, suffocation, and first dry and then moist rales are heard in the lungs.

Code by international classification diseases ICD-10:

I50.1

Predominant age- over 40 years old.
Etiology. Cardiogenic OA with low cardiac output.. MI - large area affected, rupture of the heart walls, acute mitral insufficiency.. Decompensation of chronic heart failure - inadequate treatment, arrhythmias, severe concomitant disease, severe anemia.. Arrhythmias (supraventricular and ventricular tachycardia, bradycardia) .. Obstruction to blood flow - mitral or aortic stenosis, hypertrophic cardiomyopathy, tumors, blood clots .. Valve insufficiency- mitral or aortic insufficiency.. Myocarditis.. Massive pulmonary embolism.. Pulmonary heart.. Hypertensive crisis.. Cardiac tamponade.. Heart injury. Cardiogenic OB with high cardiac output.. Anemia.. Thyrotoxicosis.. Acute glomerulonephritis with arterial hypertension.. Arteriovenous fistula. Non-cardiogenic OA - see Adult respiratory distress syndrome.

Pathomorphology of cardiogenic OA. Intra-alveolar transudate Pink colour. In the alveoli there are microhemorrhages and hemosiderin-containing macrophages. Brown induration of the lungs, venous congestion. Hypostatic bronchopneumonia. At autopsy, there are heavy, enlarged lungs with a pasty consistency, with liquid draining from the cut surface.
Clinical picture. Severe shortness of breath (dyspnea) and increased breathing (tachypnea), participation of auxiliary muscles in the act of breathing: inspiratory retraction of the intercostal spaces and supraclavicular fossae. Forced sitting position (orthopnea), anxiety, fear of death. Cyanotic cold skin, profuse sweating. Peculiarities clinical picture interstitial OA (cardiac asthma) .. Noisy wheezing, difficulty in inhaling (stridor).. Auscultation - against the background of weakened breathing, dry, sometimes scanty fine-bubble rales. Features of the clinical picture of alveolar OA.. Cough with discharge of foamy sputum, usually pink.. In severe cases - aperiodic Cheyne-Stokes breathing.. Auscultation - moist fine bubbling rales, initially occurring in the lower parts of the lungs and gradually spreading to the apexes of the lungs. Changes in the cardiovascular system.. Tachycardia.. Alternating pulse (inconsistency of pulse wave amplitude) with severe left ventricular failure.. Pain in the heart area.. In the presence of heart defects - the presence of corresponding clinical symptoms.

Diagnostics

Laboratory research. Hypoxemia (the degree changes with oxygen therapy). Hypocapnia (concomitant pulmonary diseases may complicate interpretation). Respiratory alkalosis. Changes depending on the nature of the pathology that caused AL (increased levels of MB - CPK, troponins T and I in MI, increased concentrations of hormones thyroid gland with thyrotoxicosis, etc.).

Special studies. ECG - possible signs of left ventricular hypertrophy. EchoCG is informative for heart defects. Insertion of a Swan-Ganz catheter into the pulmonary artery to determine wedge pressure pulmonary artery(DZLA), which helps in differential diagnosis between cardiogenic and non-cardiogenic OB. DZLA<15 мм рт.ст. характерно для синдрома респираторного дистресса взрослых, а ДЗЛА >25 mmHg - for heart failure. X-ray of organs chest.. Cardiogenic OB: expansion of the borders of the heart, redistribution of blood in the lungs, Kerley lines (linear striations due to increased image of the pulmonary interstitium) with interstitial OB or multiple small foci with alveolar OB, often pleural effusion.. Non-cardiogenic OB: the borders of the heart are not expanded , there is no redistribution of blood in the lungs, effusion into the pleural cavity is less pronounced.

Differential diagnosis. Pneumonia. Bronchial asthma. TELA. Hyperventilation syndrome.

Treatment

TREATMENT. Emergency measures. Giving the patient a sitting position with his legs down (reducing the venous return of blood to the heart, which reduces preload). Adequate oxygenation using a mask with 100% oxygen supply at a rate of 6-8 l/min (preferably with defoamers - ethyl alcohol, antifomsilane). With the progression of pulmonary edema (determined by the coverage of all pulmonary fields by moist coarse rales), intubation and mechanical ventilation under positive expiratory pressure are performed to increase intra-alveolar pressure and reduce extravasation. Administration of morphine at a dose of 2-5 mg IV to suppress excess activity respiratory center. Administration of furosemide IV at a dose of 40-100 mg to reduce blood volume, dilate venous vessels, and reduce venous return of blood to the heart. Administration of cardiotonic drugs (dobutamine, dopamine) to increase blood pressure (see Cardiogenic shock). Reducing afterload with sodium nitroprusside at a dose of 20-30 mcg/min (using a special dispenser) with systolic blood pressure more than 100 mm Hg. until pulmonary edema resolves. Instead of sodium nitroprusside it is possible intravenous administration solution of nitroglycerin. The use of aminophylline in a dose of 240-480 mg IV to reduce bronchoconstriction, increase renal blood flow, increase the release of sodium ions, and increase myocardial contractility. Applying venous tourniquets (tourniquets) to the extremities to reduce venous return to the heart. Sphygmomanometer cuffs applied to three limbs, with the exception of the one where intravenous drugs are administered, can be used as venous tourniquets. The cuff is inflated to values intermediate between systolic and diastolic blood pressure, and the pressure in the cuff must be reduced every 10-20 minutes. Inflating the cuffs and reducing the pressure in them should be carried out sequentially on all three limbs. The advisability of prescribing cardiac glycosides is debated. If pulmonary edema occurs against the background of a hypertensive crisis, it is necessary to administer antihypertensive drugs. Non-cardiogenic edema - see Adult respiratory distress syndrome.

Additionally. Bed rest. A diet with a sharp restriction of table salt. Therapeutic bloodletting. Ultrafiltration of blood (also to reduce blood volume). Foam aspiration in alveolar OA.
Complications. Ischemic lesions internal organs. Pneumosclerosis, especially after non-cardiogenic OA.
Forecast. Depends on the underlying disease that caused AL. Mortality in cardiogenic OA is 15-20%.
Age characteristics. Children: OA often occurs with malformations of the pulmonary system and heart or as a result of injuries. Elderly: OL is one of the most common reasons of death.

Pregnancy. Timing of occurrence of OA: 24-36 weeks of pregnancy, during childbirth and early postpartum period. The method of delivery depends on the obstetric situation. In the absence of conditions for vaginal delivery birth canal — C-section.. During vaginal delivery - application of obstetric forceps.. If there are no conditions for applying forceps - craniotomy. Prevention of acute illness in pregnant women is important: timely resolution of the issue of the possibility of maintaining pregnancy, stabilization of heart pathology in pregnant women, dynamic monitoring of the state of the cardiovascular system.

Synonyms for cardiogenic OB: . Acute left ventricular failure. Cardiac asthma.
Abbreviations. OP - pulmonary edema. PAWP - pulmonary artery wedge pressure

ICD-10. I50.1 Left ventricular failure. J81 Pulmonary edema.