AG2-PE/ARDS/ARF Flashcards
Best diagnostic tests for PE?
Angiogram (CTA) or Spiral CT
What kind of chest pain is specific to PE?
Sharp stabbing pain with tachycardia and dyspnea
After calling a rapid response what should we anticipate happen?
Administration of TPA for massive PE or Lovenox for small PE
Who should not be given TPA?
Anyone with hemorrhaging, trauma, or post surgery
Causes of ARDS r/t direct injury to the lung tissue?
Aspiration, chest trauma, PNA, near drowning, and COVID 19
Causes of ARDS r/t indirect injury to lung tissue?
Severe trauma, blood transfusions, drug overdose, pancreatitis, cardiopulmonary bypass
Mild ARDS P/F ratio?
200-300
Moderate ARDS P/F ratio?
100-200
Severe ARDS P/F ratio?
<100
When is the ARDS protocol initiated?
When P/F ration is around 300
What is ARF?
When the respiratory system fails in one or both of its gas exchange functions: oxygenation and carbon dioxide elimination. As a result the pt will experience hypoxemia or hypercapnia.
What is the most common form of respiratory failure?
Hypoxemic normocapnia (oxygenation failure) PaO2< Or equal to 60mm Hg on 60% oxygen, PaCO2 is normal
What acute diseases can cause oxygenation failure?
Pulmonary edema and PNA
What is ventilator failure?
Hypoxemic hypercapnia; PaO2< or equal to 60 mmHg on 60% oxygen, PaCO2 > 50mmHg and pH < 7.35
Causes of ventilator failure?
Drug overdose, asthma, and COPD
4 causes of hypoxemia?
V/Q mismatch, alveolar hypoventilation, diffuse limitation, and shunting
What is a V/Q mismatch?
When ventilation exceeds perfusion or perfusion exceeds ventilation
What is shunting?
When the blood returns to the left side of the heart without participating gas exchange in the lungs first.
What neuromuscular diseases may result in msl weakness or paralysis?
Guillain-Barre, muscular dystrophy, myasthenia gravis, MS
What are early signs of ARF?
Dyspnea, tachypnea, or intercostal retractions noted during inspiration
Symptoms of acidosis?
Chest pain and cardiac dysrhythmias because as acidosis increases and PaO2 decreases the myocardium becomes dysfunctional. Cerebral and kidney damage may occur if the hypoxemia is severe and prolonged.
What is an indicator of severe worsening ARF?
Paradoxical diaphragmatic movements
What is an indicator of moderate ARF?
Accessory msl use
ARDS is characterized by?
Severe dyspnea, hypoxemia refractory to supplemental oxygen, reduced lung compliance, and diffuse pulmonary infiltrates.
Common risk factors for ARDS development? Direct and indirect
Direct lung injury: Sepsis, aspiration of gastric contents , viral or bacterial PNA
Indirect lung injury: sepsis, severe massive trauma
What sx will the patient exhibit in the 1st phase of ARDS?
Tachypnea, dyspnea, cough, restlessness, confusion
What s/sx may be present in the 2nd phase of ARDS?
Tachycardia, diaphoresis, cyanosis, decreased mentation, pallor, hypoxemia despite O2, hypercapnia
What signs may be present in the 3rd phase of ARDS?
White out x ray, pleural effusions, severe hypoxemia and hypercapnia, metabolic acidosis
Possible complications in the 4th phase of ARDS?
MODS (kidneys, liver, and heart are most commonly affected)
Possible complications of ARDS?
Infection, respiratory, cardiovascular, GI, hematologist, ET tube, and CNS psychological complications.
What is hemodynamic monitoring?
When an arterial catheter is inserted for continuous monitoring of blood pressure and sampling of blood for determination of ABG values
How does dopamine and dobutamine help with ARDS tx?
It supports cardiac output and function
