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XIO > ARDs > Flashcards

ARDs Flashcards

1
Q

PATHOPHYSIOLOGY of ARDS - who gets it? and it triggers what?

A

ARDS usually occurs in a critically ill patients

ARDS triggers an immune-inflammatory response in the lungs.

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2
Q

Inflammatory mediators play

(alden’s mediators destroy)

A

a key role in damaging the lung tissue in ARDS

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3
Q

MEDIATORS (Alden mediates with a PLNC)

A

Neutrophils, Prostaglandin’s, leukotrienes, Complement System

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4
Q

MEDIATORS - TNF - released by what? (tumor nymph)

A

Released by lymphocytes when cells are injured

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5
Q

Endotoxin - caused by what

A

Toxic proteins released from bacterial growth
Usually from hypofunctioning gut
Can lead to Sepsis

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6
Q

Clinical Criteria for diagnosing ARDS - onset

A

ACUTE ONSET

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7
Q

↓ Oxygenation as measure by PaO2/FiO2 ratio - what number

(Alden won’t live to 200)

A

(ARDS= <200)

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8
Q

FORMULA FOR PaO2/FiO2 ratio

(pa’s artery is first)

A

PaO/FiO2 ratio (PaO2 ÷ FiO2)
PaO2 = Partial pressure of arterial oxygen (mm Hg) Measured on an ABG

FiO2 = Fraction of inspired oxygen (O2 concentration) Room air = 21%

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9
Q

PaO2/FiO2 -The lower the ratio…

A

the greater the shunting

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10
Q

PaO2/FiO2 - ranges

(pa starts at 350)

A

Normal: greater than 350 mm Hg
Acute lung injury: less than 300 mm
ARDS: less than 200 mm Hg

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11
Q

Pulmonary Artery Wedge Pressure (PAWP)

(alden’s wedgy was under 18)

A

Pulmonary Artery Wedge Pressure (PAWP) (this is measured from a swans catheter) normal or not greater than 18mm Hg (anything greater than 18 is cardiac)

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12
Q

Clinical Criteria for diagnosing ARDS - edema?

A

Non cardiac bilateral pulmonary edema. (Cardiac pulmonary edema is what is causing the high PAWP > 18)

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13
Q

REVIEW CRITERIA for ARDS: - on TEST (5 things) KNOW THIS

(Alden is fast, dying at 200 and 18 with fat consolidation)

A

Acute Onset
PaO2/FIO2 ratio < 200
PCWP < 18 mm HG
Non Cardiac Pulmonary edema
CXR: Diffuse bilateral alveolar infiltrates→ consolidation (white-out)

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14
Q

TREATMENT for ARDS (the usual)

A

Ventilation support
Fluid Management
Nutritional Support
Positioning and other therapies

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15
Q

VENTILATION SUPPORT- high or low?

A

Pt needs ventilator support
High Vent settings can cause Barotrauma

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16
Q

BAROTRAUMA - what to check for?

A

Subcutaneous Emphysema
Air noted in subcutaneous tissues upon palpation. (this is bc the vent setting is up too high)

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17
Q

VENTILATOR SUPPORT IN ARDS - to prevent Barotrauma,

(Alden needs a small tide)

A

smaller tidal volumes can be used.
Unfortunately, smaller tidal volumes cause CO2 retention.

18
Q

ARDS: MEDICAL AND NURSNG MANAGEMENT - NUTRITIONAL SUPPORT

A

Early initiation of nutritional support is Vital!

Severe hypermetabolism occurs– equated to running an 8-minute mile, 24 hours per day, 7 days a week.

The enteral route (below pyloris) is preferred to parental to normalize the gut and minimize gut hypoperfusion → ischemia → translocation of endotoxins → sepsis

19
Q

FLUID SUPPORT in ARDS -

(alden can’t have too much fluid)

A

Give adequate fluids but keep pt fairly dry
Intravascular fluid ends up leaking out into the lungs due to ↑ capillary membrane permeability.

20
Q

POSITIONING TREATMENT IN ARDS - prone? and what does it improve?

(alden is prone)

A

Dependent lung areas are more heavily damaged than non dependent lung areas.

Prone positioning improves V/Q matching

More effective when initiated in the early phases of ARDS.

Prone positioning is labor intensive (may require 7 staff members), can result in accidental extubation, hemodynamic instability, facial edema, ↑ ICP, corneal abrasions.

21
Q

Prostacycline - what does it do?

(Alden’s prosty dilates)

A

Selective Pulmonary vasodilator (SPV)
Improves PaO2 / FIO2 ratios
Marked dose related improvement in oxygenation

22
Q

Review of Treatment for ARDS - is the oxygen high or low?

A

Intubate
ICU
High peep and low tidal volumes
Prone positioning
Aerosolized Prostacyclin via jet neb

23
Q

O2 levels - L/min - the numbers

A

up by 4 starting at 24%

24
Q

xrays for ARDs will show

A

Diffuse bilateral alveolar infiltrates→ consolidation (white-out)

25
Q

what do mediators do?

(alden’s mediators are leaky)

A

These mediators cause extensive lung damage, ↑ capillary membrane permeability and ‘leaking’ in ARDS

26
Q

what does the inflammatory response do to the lungs? (what is injured?)

A

The inflammatory response injures the alveolo-capillary membrane and causes severe pulmonary edema.

27
Q

what does TNF do during ARDS? (2 things)

(think what mediators do)

A

In ARDS causes endothelial injury, vasodilation, ↑ capillary permeability

28
Q

criteria for ARDS - chest xray?

A

BILATERAL INFILTRATES ON CXR

29
Q

criteria for ARDS - Pulmonary Artery Wedge Pressure (PAWP)

A

Pulmonary Artery Wedge Pressure (PAWP) not greater than 18mm Hg (normal 6 – 12)

30
Q

criteria for ARDS - pulmonary edema?

A

Non cardiac bilateral pulmonary edema. (Cardiac pulmonary edema causes ↑ PAWP > 18)

31
Q

criteria for ARDS - oxygenation?

(alden’s 02 won’t last 200 minutes)

A

↓ Oxygenation as measured by PaO2/FiO2 ratio (less than 200 = ARDS)

32
Q

PaO2/FiO2 ratio - The lower the ratio…

(low shunts)

A

the more intrapulmonary shunting.

33
Q

normal PAWP - number

(pa should be 6 - 12)

A

(normal 6 – 12)

34
Q

ventilation support in ARDS - is Hypercapnia ok? And what numbers?

(Alden is hyper at 50)

A

Permissive Hypercapnia (50 – 70 meq/L) is allowed
Normal 38-42

35
Q

ventilation support in ARDS - PEEP

(alden is my peep)

A

PEEP (positive end-expiratory pressure)
Keeps alveoli slightly expanded
Too much PEEP can put pt at risk for Barotrauma

36
Q

prone position - how often to reposition head?

(alden needs to breathe every hour)

A

Reposition head every hour, continue enteral tube feeding, turn to supine within 6 hours.

37
Q

prostacycline - how much?

(prosty in 0 to 50)

A

Given via aerosolized jet nebulizer at 1 – 50 ng/kg/min

38
Q

to calculate ARDS

A

PAO2 = 98% and FiO2 = 50%

98 / .50 = 196 (ARDS)

39
Q

ARDS - metabolism?

A

severe hypermetabolism

40
Q

most sensitive marker for SIRS?

(Alden can’t breathe!)

A

tachypnea

XIO (372 decks)

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