Pitting Edema 

Edema is the collection of watery fluid within any cavity of the body that produces swelling. Though the causes vary, the end result is injury or inflammation resulting in leaky blood vessels. When those vessels leak, they produce swelling. This swelling might be limited to a localized region, or may produce more generalized swelling. In some cases, take for example an infection, those leaky blood vessels are likely to call more white blood cells to the injured area and help battle infection. However, in other cases, this swelling can cause tissue and organ damage.

In EMS, we need to evaluate areas of edema and try to locate their cause. Here are some questions to consider asking during your assessment:

• Have you noticed the swelling in this area?
• Is this new for you or do you always have swollen ______?
• Are your _______ more swollen than normal?
• What do you normally do to get relief from the pain your swelling is causing?
• When was the last time you saw your doctor?
• What does your doctor want you doing to keep the swelling down? Are you doing those things?
• Do you have a history of heart disease? If so, are you being treated for it?
• Do you have any history of tumors or blood clots?

Crazy how one finding can spur so much discussion! We, as EMS providers, will most likely see edema from DVT’s, burns, allergic reactions, or CHF (Congestive Heart Failure). Let’s go over why we’re seeing edema in each of those conditions/injuries:

DVT (Deep Vein Thrombosis)

• If there is a clot or a blockage in the veins, blood will back up, just like cars in a traffic jam. Blood will begin to leak out of the vessels as it remains stagnant in an area. With DVT’s you can also have temperature differences in the affected leg compared to the rest of the body. It may also be painful, so treat their pain per local protocols.

Burns

• With burns, there has been an insult to the tissues. Blood vessels have been damaged and will leak into the surrounding tissues. This can be a life-threatening situation as the swelling can affect breathing and circulation.

Allergic Reactions

• Anaphylaxis is an exaggerated response to a foreign protein that your body does not like. The body in this case actually allows the blood vessels in the affected area to leak into the tissue to battle the foreign protein.

CHF (Congestive Heart Failure)

• This is a perfect name for the condition. The heart is slowly failing and fluid backs up as the pump slows down. This fluid can build up in the lungs and cause pulmonary edema (left side of the heart), or fluid can build up in the legs or abdomen (right side of the heart).

But What About Pitting Edema?

Pitting edema is demonstrated by using the forefinger to push in the swollen area. This creates an indentation in the skin. The time it takes for the skin to return to normal is also a key finding. In a study by S.B. O’Sullivan and T.J. Schmitz that was published in 2007, “Physical rehabilitation: assessment and treatment,” they developed the following table by which to describe pitting edema: