Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NSCC 7520 Critical Care Theory 4 > ARDS > Flashcards

ARDS Flashcards

1
Q

What is ARDS

A

systemic process - lung MODS

non-cardiogenic pulmonary edema

severe hypoxemia resistant to oxygen

decreased lung compliance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

T or F ARDS can be caused directly or by indirect injury

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are 6 direct ways ARDS can be caused

A 
aspiration
near drowning
toxic inhalation
pulmonary contusion
pneumonia
oxygen toxicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are 6 indirect injury causes of ARDS

A 
sepsis
non-thoracic trauma
hypertransfusion
severe pancreatitis 
shock states
drug overdose: ASA, opioids, cocaine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the major precipitating event for ARDS

A

Sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the ABCCs of infection/inflammation

A

arachdonic
bradykinin
coagulation
complement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the end result of the arachadonic pathway in the ABCCs of infection/inflammation

A

vasodilation
vasoconstriction
increased permeability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the end result of the bradykinin pathway in the ABCCs of infection/inflammation

A

potent vasodilation

increased permeability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the end result of the coagulation pathyway of ABCCs of infection/inflammation

A

micro-emboli formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the end result of the complement pathway of ABCCs of infection/inflammation

A

intensify inflammation
damage endothelium
cell adhesion and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What 3 things that occur in sepsis can lead to the cause of ARDs

A

vasodilation
capillary permeability
maldistribution of blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what do the ABCCs of infection/inflammation do to cause ARDs

A

alveolar epithelial changes
airway changes
endothelial changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the 4 stages of ARDs

A

exudative
proliferative
fibrous
resolution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

when does the exudative phase occur

A

w/in 24-72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

when does the proliferative stage occur

A

day 2-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

when does the fibrous stage occur

A

> 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

when does resolution occur

A

several weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What happens in the exudative phase (5)

A

inflammatory mediators increase permeability of capillary membrane

fluid rich with protein, blood cells and fibrin leaks into pulmonary interstitium

alveolar cells type 1 - wall integrity becomes compromised
alveolar cells type 2 - damage causes loss of surfactant

microemboli cause pulmonary artery pressure to rise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What occurs in the fibroproliferative phase (4)

A

disordered healing

cellular granulation and collagen deposition occur within the alveolar-capillary membrane

alveoli become enlarged and irregular shaped (fibrotic)

further stiffening and decreased compliance increasing pulmonary HTN and hypoxemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What occurs in the resolution phase (2)

A

recovery occurs over several weeks

structural and vascular remodeling takes place to re-establish alveolar-capillary membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What imaging is done to support a diagnosis of ARDs what does it look like

A

bilateral opacities - not fully explained by effusions, lobar/lung collapse nodules
‘white out’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What do we look at to quantify intrapulmonary shunting

A

PaO2/FiO2 ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is a normal PaO2/FiO2 ratio

A

> 300 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the numeric value for normal intrapulmonary shunt

A

3-5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What defines mild ARDs
PaO2/FiO2 200-<300 w PEEP or CPAP > or = 5
26
What defines moderate ARDs
100 -200 < PaO2/FiO2 with peep >/= 5 | Shunt 15-20%
27
what defines severe
= 100 PaO2/FiO2 with Peep >/= 5 | > 20% shunt
28
what will initial ABGs show for ARDs
hypoxemia respiratory alkalosis from breathing off CO2 increased RR
29
What happens to a patients RR as ARDS progresses
decreases d/t fatigue
30
If you have a PA line in an ARDs pt what will you see
increased PADP while PCWP is unaffected | increase in difference >1-4 mmHg
31
What type of history would lead us to suspect ARDs
direct pulmonary insult or systemic inflammation
32
what timing would lead us to suspect ARDs
within a week of worsening symptoms
33
what types of assessment findings would lead you to suspect ARDs
coarse crackles in lung fields | High PIP and/or plateau pressures indicating worsening compliance
34
what are two ventilator findings that would indicate ARDs
increased PIP and Plateau pressures indicating worsening compliance
35
What diagnostic findings would indicate ARDs (3)
patchy infiltrates or opacities on CXR non-cardiac pulmonary edema worsening PaO2/FiO2 ratio
36
What part of cardiac output does ARDs affect
increased rt ventricular afterload causes decreased CO
37
what type of V/Q mismatch occurs in ARDs
both! Shunting - thickened A-C membrane and inc. airway resitance deadspace - micro-emboli form pulmonary HTN
38
what are early systemic findings in ARDs by system
CNS - restlessness CVS - tachycardia GI/GU - no appetite decreased UO
39
what Lab values would you see in early ARDs
low pO2 low CO2 alkalotic pH SvO2 low
40
What systemic findings would you see later in ARDs
CNS - agitation, fatigue CVS - tachycardia, full blow s/s of decreased afterload generalized edema multiorgan involvement
41
what lab values would you see later in ARDs
resp acidosis inc lactate low SvO2 OER inc
42
what is the 2 pronged approach to treatment of ARDs
1. treat causative factor if able - i.e pneumonia abx | 2. support physiological fn and cellular oxygenation until the effects of ARDs/SIRS subside
43
what are the 4 areas of treatment to support ARDS pts
MV hemodynamic support positioning pharmacology
44
What are 3 MV protective lung strategies for pts with ARDs
maintain plateau pressures < 30 cm H20 use low tidal volumes permissive hypercapnia
45
What does PIP reflect
lung compliance and airway resistnace
46
is PIP representitive of static or dynamic compliance
dynamic
47
what is normal PIP
< 40 cm H20
48
When is a plateau pressure measured
end of inspiration when the lung is fully inflated but no air is moving in or out
49
what is plateau pressure representive of
lung compliance
50
is plateau pressure dynamic or static
static
51
what value is most accurate in determining lung compliance
plateau pressure
52
what is normal PP
25-30 cm H2O
53
what button is pressed to determine PP
end-inspiratory hold button
54
What ventilator settings have a decreased mortality and ventilator days in ARDS
TV <6 cc/kg and PP <30
55
What is regional over-distension in ARDS
preset volume modes air flows into most complaint alveoli causes some alveoli to be over distended and others to be underinflated
56
What is the problem with AC ventilation in ARDS
regional over-distension in ARDS
57
what can happen with regional overdistension in ARDS
alveolar wall trauma and cellular injury can increase atelectasis can cause pneumothorax
58
What should you keep tidal volumes in ARDS pts
btwn 4-8 ml/Kg
59
What is permissive hypercapnia? why is it a protective lung strategy
allowing pCO2 to rise with low tidal volumes preferable not to drop pH below 7.2 avoids volume and barotrauma that might come from increasing PCV to increase ventilation
60
why do we not increase RR to blow off rising pCO2
decreased time for resp cycle cases increased flow rate d/t dec. in inspiration time lung tissue has less time to stretch and accommodate incoming volume increases airway and alveolar pressure
61
If your TV is decreaseing what are 4 things this could mean
decreased lung compliance worsening ARDS secretions need suctioning leak in circuit
62
T or F volume-cycled ventilation decreases the risk of volutrama and barotrauma
false - PC reduces risk of barotrauma and volutrauma
63
3 benefits of PC
improve ventilation d/t decelerating inspiratory flow pattern laminar flow opens smaller collapsed airways improve oxygenation by decreasing V/Q mismatch
64
what can we do with MV to improve refractory hypoxemia
increase PEEP sometimes as high as 15-18 | keep FiO2 levels as low to prevent alveolar damage from O2 toxicity
65
What are the two types of ECMO
VA | VV
66
what type of ECMO provides cardiac support to assist systemic circulation
VA
67
What type of cannulation does VA require? VV?
VA - arterial and venous | VV - venous only
68
What type of ECMO bypasses pulmonary circulation
VA
69
what type of ECMO maintains pulmonary blood flow
VV
70
What type of ECMO would you use for RV failure
VA
71
Which type of ecmo acheives a higher PaO2
VA
72
What type of ECMO is connected in series to heart and lungs? parallel to heart and lungs?
VV series to heart and lungs | VA parallel to heart and lungs
73
what are our two hemodynamic goals in ARDS
maintain preload | avoid excessive fluid
74
what type of fluid management do we do with ARDS pt
biphasic hemodynamic instability - early fluid administration once initial phase of instability has passed then restrictive fluid strategies
75
what type of fluid do we use with ARDS
remains isotonic crystalloid
76
what is normal PAS/PAD
20-30/10-15
77
what is normal PCWP
8-12
78
what is normal SVR
800-1500
79
What is normal PVR
155-255
80
what is normal CO
4-8
81
What should the difference btween PCWP and PAD be
1-4 mmHg
82
if there is difference >4mmHg btw PCWP and PAD what does this indicate
lung pathology
83
what is something we can get for our ARDS pts that maximizes ventilation and perfusion
kientic bed
84
what does a kinetic bed do
constant repositioning maximizes ventilation and perfusion improving gas exchange
85
What position is beneficial in ARDS pts? why?
proning | improves lung persusion in dependent lung zones
86
how long should ARDS pts be placed in the prone position
12-16 horus
87
how many people does it take to prone a pt
3-4 RNS and one RT
88
what are 3 side effects of proning a pt
potential tube or line dislodgement pressure wounds, pressure neuropathy facial edema
89
What RASS goal do we typically aim for with ARDS pts
-3 to -5
90
why do we want ARDS pts sedated
decrease demand easier to ventilate promote patient comfort while on ventilator
91
What type of drugs do we expect to use with ARDS pts
bronchodilators | mucolytics
92
have surfactant replacement drugs shown benefit in ARDS pts
no
93
what mediaction might be used as a last effort to imrpove oxygenation for ARDS pts
nitric oxide
94
what does nitric oxide do
``` vasodilation of capillary bed reduces PVR improves blood flow reduces V/Q mismatch decreases O2 toxicity decrease high PEEP requirements ```
95
What are 2 side effects of nitric oxide
interacts with Hgb to form methemoglobin | can cause renal dysfunction
96
late stage blood gas for ARDS will show what
mixed acidosis
97
What PA values will be abnormal in ARDS
``` decreased SVR d/t to ABCCs of inflammation increased PVR (increased RT sided afterload) increased PAD (left sided preload) ```
98
if you have high PCWP and PADP greater than 4 what does this indicate
HF
99
will PCWP be affected in ARDS
no
100
if you hear bronchial breath sounds in the lower and mid lung fields what does this mean
consolidation happening in the lungs
101
what happens during alveolar epithelial changes
type 1 cells wall integrity compromised causing shift in fluid and protein type 2 cell damage causes loss of surfactant
102
What happens to O2 supply and demand during alveolar epithelial changes
decreased SA thickened membrane decreased diffusion and decreased alveolar oxygenation
103
what TV do you expect to see for decreased mortality in ARDS pts? PP?
<6 cc/Kg | <30 cm
104
What type of pt must you be mindful of with permissive hypercapnia
TBI | high CO2 causes cerebral vasodilation which can cause increased ICP
105
what vent settings places a pt at risk for regional overdistention
volume cycled, AC
106
why do you want to avoid excessive fluid resuscitation in ARDS pts
dont want to overload them and cause more fluid to back up into the lungs
107
what type of blood gas will you see in a patient who is being diuresed with lasxi
metabolic alkalosis
108
how should you be giving fluids in patients
slowly and carefully as pt already has fluid in the lungs
109
What is the main thing positioning addresses
V/Q mismatch
110
what are benefits to proning
expands alveoli as heart is not pushing down on them as seen in supine allows for better oxygenation of dependent side of lung as the fluid will move via gravity
111
what are the two types of patients you will never do a sedation vacation on
ARDS | TBI
112
what is another drug that can be used aside from nitric oxide in ARDS pts
flolan (prostacylcin)
113
how do flolan work
used in pulmonary htn to vasodilate pulmonary arteries | cheaper than nitric oxide

NSCC 7520 Critical Care Theory 4 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions