Okay, now that you're a rockstar about how
congestive heart failure causes pulmonary edema,
I want to introduce you to some other causes.
So if someone's had a heart attack or other
heart diseases, that can cause pulmonary edema
because a heart that can't pump as strong as it used to because
it has damage from a heart attack or a myocardial infarction
or some other damage to the heart that's gonna cause a
risk of heart not being able to function efficiently,
fluid's gonna back up and
where it backs up is in the lungs.
You can also have problem with damaged heart valves.
Now the purpose of heart valves, if
you've ever looked at this, you see like
they're supposed to keep blood flowing in one
So when your systole, right? These valves in
the top they open up and blood pushes through
but in diastole, when the heart relaxes,
those valves close, other valves open.
So if those valves are leaking or they're
narrowed or they're damaged in any way,
blood is not gonna flow efficiently
because of the problem with the heart valves.
Any problem that makes the heart less efficient put your
patient at risk for stuff bacing up and pulmonary edema.
That's why shortness of breath is so
associated with anyone with heart problems.
If someone has super high blood
pressure, that might also be a problem.
Aah yeah, this is an easy one.
You already know that right? because
we talked about chronic hypertension.
It causes that left ventricle to have to work really
Well if someone has super high blood pressure really quickly,
again the ventricles are going like, "hey what is going on here?"
So again blood may back up and cause
Now high altitude, holy cow! if you've ever
been up to like the mountains of Colorado
you've experienced something
like this you don't ever forget it.
I'll break that down a little more for you.
Also kidney failure, they're very involved in fluid volume balance
so patient in kidney failure can also develop pulmonary edema.
Now lung damage if they've got a really
bad infection can also trigger pulmonary edema
and fluid leaking into spots we don't want it to.
Lastly, severe sepsis.
Okay, that's a really significant infection of the
blood or blood poisoning as caused by an infection,
also leads to pulmonary edema
and all kinds of complications.
So woah, that's a big list.
Don't you hate it when you're trying to
study and you look at this, you're like,
"Okay there is no way I'm
gonna remember 4000 things".
You don't have to
What you need to remember is causes of
pulmonary edema can be damage to the heart
or direct damage to the lungs or kidneys.
So pulmonary edema, never good sign,
it's always a sign of fluid volume overload.
Either I took a healthy person with a normally functioning
heart and I just was slam them with way too much fluid
or I have a heart that's sick and you can't
pump the amount of fluid it has around in the body.
So it's all about organ failure right?
Heart, lung or kidney damage
can give us a real issue.
In sepsis, I've got inflammation
and problems everywhere.
so think about chunking information,
putting big pieces together
because I promise you, you can make up all the
kind of mnemonics you want to for all these things
but once you get like 400 mnemonics
in your head, you can't remember it all.
So understanding, that's why
you were so careful to step through .
reminding you how the blood flow works
in the heart, why it would be very clear to you,
why back up on that left side is
gonna cause pulmonary edema
and the other should more easily fall into place with
just simple periods of practicing this in your own time.
Okay, so let's talk about heart attack.
You already know, I see you already have this, I
love it, you're doing really well staying up with us.
So heart attack, myocardial infarction.
Infarction means dead tissue.
So see we've got a close-up for you there, that kind
of a black stuff, yeah that's tissue, that's no bueno.
And remember, dead tissue can't
conduct those electrical signals anymore.
You know in your heart it pumps because,
SA node, AV node, bundle of His, Purkinje fibers
It doesn't matter what your purkinje fibers
going through your body, I mean your heart
It can't send a signal there to tell that muscle to
contract so that muscle is essentially stiff and useless.
So the larger the heart attack or the larger than myocardial
infarction, the worst problems your patient's gonna have.
So because infarcted tissue is dead tissue.
Dead tissue is stiff tissue so the heart
can't contract and expand efficiently,
can't respond to the electrical pacemaker
of the heart that's why a heart attack,
patients afterwards can really be at risk for
pulmonary edema and even congestive heart failure.
Now let's look at those valves.
You already know why this is a problem,
right? See, you are learning so quickly, well done.
So the valves, look we've showed you what normal valves
are supposed to look like and then when they're not normal.
These are some weird-looking valves.
But remember a valve's job is to be, let blood go one direction,
not allow stuff to back up or flow the opposite direction.
So when valves are damaged, blood
flow backs up and causes pulmonary edema
mostly from the left atrium, mitral
valve, left atrium back into the lungs.
Yeah, I told you, you've got this, good job.
NowI iwant to talk to you about high
altitudes, I've had altitude sickness one time
Again, would I recommended it? Severe headache, I was
nauseated, super dehydrated but this is one step worse.
High altitude pulmonary edema.
This was my first adventure being a camp nurse.
And I was on one side of the camp and my
colleague called me to the other side of the camp
and they asked me to look at
this kid whose name was Dusty.
Wow that was appropriately name
because I walked into his room and thought,
Oh my goodness, here is this
junior high boy looking blue.
He looked horrible and you know when someone's blue,
it's really really bad, we've missed some earlier signs
Well Dusty was experiencing
high altitude pulmonary edema.
My first thought was, if I was at work I'd be
running the crash cart into this gentleman's room
but I wasn't at work I was in a camp in the mountains.
So this boy ended up being ambulanced
out in the hospital to intensive care.
Here's what happened to Dusty:
he had high altitude pulmonary edema, so he had really low
oxygen in the blood which we are all experiencing, right?
Because the altitude causes a
hypoxic pulmonary vasoconstriction.
Okay, so high altitudes, we have lower oxygen in the blood
and you've got this hypoxic pulmonary vasoconstriction.
Well anytime those vessels constrict, I know that
in my blood pressure, my blood pressure goes up.
Same thing happens in your lungs because of
the low oxygen that's available in the mountains
then you have this pulmonary vasoconstriction.
That means a pulmonary
artery pressure is also elevated.
Okay, high altitude low oxygen hypoxic pulmonary
vasoconstriction is a result of that low oxygen
then you have elevated pulmonary artery pressure,
now fluid leaks from the vessels into the alveoli.
So here was this junior high boy in severe
pulmonary edema that's why he was blue.
He struggled with this during the
night before they came to get the nurse
so we saw him, we knew it was time to go.
Now this story has a great ending
because he recovered, he did well
Of course, this patient's raced up to Colorado to see
him, he did well and he became super fit and buff,
very strong young man lived to healthy life.
But because of this HAPE and this
pulmonary edema, if we wouldn't have got to him
this story might have had
a very, very different ending.
So remember, high altitude, low oxygen,
increased vasoconstruction because
becaude hypoxic, low oxygen pulmonary
vasoconstriction elevated pulmonary artery pressures,
fluid leaks into the vessels, the alveoli makes
some little water balloons like you see there
and that's what almost had a
very sad ending for my friend.
But luckily, that story has a happy ending.
Now let's look at role of the kidneys.
You know the kidneys play a major
role in fluid-volume balance in the body.
Okay, so yes you knew that
but remember that's great.
Celebrate the things you know because
you're learning more than you realise everyday.
I know doesn't feel that way
sometimes in school but you really are.
So you know the kidneys play a
major role in fluid-volume balance.
Okay, so if the kidneys are failing, now
we're gonna have fluid-volume overload
Ooh, there you go, you already know that
edema is fluid the leaking into the tissues
and it's because you end up with pulmonary edema
because there's more than the body can handle.
Well if the patient's in renal failure, a classic sign
that you've got extra volume or fluid volume overload
and that's why you can end up with it
backing up and leading to pulmonary edema.
Also, we talked about lung damage.
You have a severe infection of the lungs or the lung
tissue's impacted from its severe inflammatory response,
that can cause fluid to leak into the alveoli
Now sepsis, well we'll do separate presentations on
sepsis but we want to put it in here to remind you
So in sepsis, the capillaries become
damaged and the body's in inflammatory response.
so sepsis is a really severe condition for
a patient and the reason they have leaking,
is because of this inflammatory
response, the capillaries become damaged
and then you end up with fluid
leaking other vessels into the tissues.
Again, in sepsis it's not just in the lungs.
In sepsis, you can end up all your circulatory systems,
so I've had some amazing stories not in a good way
of patients that we knew they were septic, we kept putting
fluid in them to try to bring the blood pressure up
They're on all kinds of vasoactive drips but everything we
put into their veins just went straight into their tissues.
The patient just blew up and
we still didn't win that battle.
So sepsis, widespread, it's an infection in the
bloodstream and ends up attacking all these capillaries.
They become damaged and so fluid will just fill up
the tissues all over the body, including the lungs