so this presentation is going to be on the levels of pitting edema and uh how to grade pitting edema but uh before we begin we have to talk about the fact that not all edema is pitting edema there are many uh different causes of Edema um two of which are hydrostatic pressure and uh decreased oncotic pressure which is the proteins in the blood both of those result in pitting edema typic typically and and one of the one of the causes of non-pitting Edema is a lymphatic obstruction so the P pitting EMA grading scale is uh typically based off one to uh one to four levels there are many different uh variations of uh specific rules that uh different ones can follow but uh typically they they are somewhere something as the following so the plus is uh obviously no no pitting Adema sometimes it can be referred to as uh zero Z Plus the uh one next level up is a one plus pitting edema and this is a slight pitting edema and uh you know it's it's hard to see it's hard to see this level of Edema without actually putting your hands on the patient so good uh tip is to uh check for this type of AO when you're checking for people beetal pulses and uh stuff like that and so the OnePlus pining EMA is approximately 2 mm uh when you push down it's a two 2 mm indentation approximately and it disappears almost immediately when you remove your finger so uh there's no remaining marks so The Next Step Up is a two plus pitting edema this is mild pitting edema and the indentation is approximately 4 millimet when you push your finger down and uh different uh guidelines have different times but typically it's about uh 10 to 25 seconds it's a short amount of time and it usually uh goes back to normal and you can't tell that uh you've pushed down on the skin so the three plus pitting EMA is moderate pitting EMA and this is when the indentation is between four and six mm in depth and this lasts for a significant amount of time uh often times more than one minute and typically by this uh by this point the edema is obvious to the naked eye and you'll be able to see that somebody is a damus so the four plus pinning edema is severe pitting EMA it's 6 millim indentation or more and it lasts a severe amount of time once again it's it's obvious when somebody has four plus pitting EMA it's obvious that they're adius in whatever extremity that uh the edema is present and the the texture of pining em four plus pting EMA is almost as if it was Plato where you can mold and shape their uh their extremities because the pitting edema lasts for so long and once again the four plus pitting edema is the highest and final stage of the pitting Adema scale