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Internal Medicine RS > Acute Respiratory Distress Syndrome > Flashcards

Acute Respiratory Distress Syndrome Flashcards

1
Q

What is ARDS ⁉️

A

It’s a hypoxemic respiratory failure due to systemic or pulmonary inflammation without evidence of heart failure or pulmonary hypertension

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2
Q

When the acute lung 🫁 injury turns into ARDS ⁉️

A

When it’s very severe

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3
Q

What happened to the pulmonary capillary wedge pressure in ARDS ⁉️

A

🔸It’s stayed normal
🔸less than 18

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4
Q

What is the mechanism of ARDS

A

🔸systemic or pulmonary inflammation
🔸increases the capillary permeability
🔸accumulation of fluid between the alveoli and the blood vessel
🔸that will decrease the O2 diffusion
🔸increase the pressure outside the alveoli and causes lung 🫁 collapse

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5
Q

What is the difference between ALI and ARDS ⁉️

A

🔹PO2:Fio2 less than 200
🔹PO2:Fio2 less than 300

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6
Q

Risk factors for ARDS ⁉️

A

🔹direct lung injury
🔹systemic inflammation

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7
Q

Direct lung injury that causes ARDS 🫁

A

🔆pneumonia
🔆fat embolism
🔆drowning
🔆inhalation injury
🔆aspiration of gastric contents

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8
Q

Systemic causes that lead to ARDS ⁉️

A

🔹sepsis
🔹shock
🔹pancreatitis
🔹drug overdose
🔹massive transfusion

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9
Q

The main two factors in the ARDS ⁉️🫁

A

🔹 ⬇️surfactant
🔹⬆️endothelial damage and capillary permeability
🔹⬆️alveolar collapse

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10
Q

What are the 3 phases of ARDS ⁉️

A

🔹exudative phase
🔹proliferation phase
🔹fibrotic phase

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11
Q

What happened in the exudative phase of ARDS ⁉️

A

🔹it takes 7 days
🔹damage of type 1 alveolar cell
🔹damage of vascular endothelium
🔹leakage of water,proteins,inflammatory cells into the intrerstium between alveoli and capillary
🔸producing of hyaline membrane
🔸each lung weight 1000 instead of 200

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12
Q

What happened to the proliferation phase in ARDS ⁉️

A

🔸1-3 weeks
🔸damage to type 2 alveolar cell➡️that will decrease the surfactant
🔸parietal fibrosis and remolding

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13
Q

What happened in the fibrotic phase of ARDS ⁉️

A

🔹more than 3 weeks
🔹end stage fibrosis
🔹collagen deposits

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14
Q

How we could differentiate between ARDS and respiratory failure due to cardiac conditions or pulmonary hypertension

A

By using Berlin score

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15
Q

Berlin definition of ARDS ⁉️

A

🔆1 week of respiratory symptoms onset or acute worsening
🔆bilateral opacities on X-ray 🩻
🔆RF not explained by Cardiac failure 🫀or fluid over load
🔆imparted oxygenation

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16
Q

The X-ray 🩻 findings in the ARDS ⁉️

A

🔸non specific
🔸resembling pulmonary edema and hemorrhage
🔸diffuse bilateral opacities
🔸the findings develop with in 12-24 hours

17
Q

What is the x-ray 🩻 findings that we could see within 12-24 hours ?

A

Bilateral opacity

18
Q

What is the X-ray 🩻 finding that we can see after the first week ⁉️

A

Hyaline membrane ➡️due to type 1 alveolar cell damage

19
Q

What is the difference between ARDS EDEMA AND CARDIC EDEMA

A

The cardiognic pulmonary edema relived by diuretic

20
Q

What is FIO2 ⁉️

A

🔆It’s fraction of inspired o2
🔆it’s percentage of O2 inspired in the volume of air
🔆in the natural air it’s 21%

21
Q

What is the FIO2 in the enriched air ⁉️

A

🔹could reach 100% instead of 21%

22
Q

What is PEEP ⁉️

A

🔺it’s positive end expiratory pressure

23
Q

Positive end expiratory pressure is ⁉️

A

When the alveolar pressure is above the atmospheric pressures at the end of expiration

24
Q

We have two different types of Peep. ⁉️

A

🔆intrinsic ➡️applying by a ventilator
🔆extrinsic ➡️applied by incomplete exhalation

25
Q

Impared oxygenation ⁉️

A
26
Q

What are the test we used for diagnosis of ARDS. ⁉️

A

🔆ABG 🩸
🔆echo 🫀
🔆BNP🫀
🔆pulmonary wedge pressure 🫁
🔆thorax CT scan 🩻🫁
🔆amylase and lipase

27
Q

The normal BNP results ⁉️

A

Less than 100 nano gram ➡️beta natriuretric peptide

28
Q

Main mangment for ARDS 😵‍💫

A

🔸oxygenation
🔸prone position
🔸Iv fluid
🔸Ab
🔸supportive infection

29
Q

Oxygenation for the ARDS treatment ⁉️

A

🔹O2 sat should be between 88-95
🔹we start with noninvasive ventilation
🔹then we use The endotracheal intubation

30
Q

When we use the prone position as a treatment ⁉️

A

🔸patient with severe ARDE ➡️ratio less than 150
🔸it has some complications

31
Q

What are the complications of prone position to treat the ARDS⁉️

A

🔆facial edema
🔆pressure sore
🔆dislodgement of endotracheal tube

32
Q

IV fluid for ARDS mangment ⁉️

A

🔹we should insert central line to monitor the CVP
🔹the goal is to keep the cvp less than 4

33
Q

Antibiotics for ARDS management ⁉️

A

🔆we use the specially with ➡️sepsis and pneumonia
🔆we should make a culture sample from sputum,blood,urine to know the causative microbe 🦠

34
Q

What type of supportive care we could provide for ARDS patients in the icu ⁉️

A

🔸thrombosis prophylaxis ➡️to prevent DVT
🔸blood glucose levels control
🔸gastrointestinal bleeding prophylaxis ➡️due to stress
🔸blood transfusion
🔸pressure monitoring ➡️above 60
🔸nutri
🔸corticosteroid or beta agonist is not recommended

35
Q

Mortality rate of ARDS ⁉️

A

40%

36
Q

Manifestation after recovery ❤️‍🩹

A

🔆some pulmonary symptoms

Internal Medicine RS (10 decks)

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