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Respiratory > ARDS > Flashcards

ARDS Flashcards

1
Q

What is a complex clinical syndrome rather than a single disease and has a high mortality rate?

A

ARDS

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2
Q

What is Acute and typically develops in 4 to 48 hours after the insult?

A

ARDS

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3
Q

Direct Injuries of ARDS

A

Aspiration, Infections (pneumonia), Trauma, Toxic Inhalations, Upper Air Obstruction, Pulmonary Edema

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4
Q

Indirect Injuries of ARDS

A

Sepsis (most common), Burns, Trauma, Blood Transfusion, Drug and Alcohol overdose, Acute Pancreatitis, Air and Fluid embolism, Fractures, Bypass

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5
Q

Most Risk of developing ARDS

A

Age >65, Severe Acute illness, Sepsis, Chronic disorders

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6
Q

SIRS manifested by 2 or more of these signs?

A

Temp > 1000.4, HR >90, RR > 20 or PaCO2 <32, WBC > 12,000

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7
Q

ARDS patient per 100,000 rate?

A

38-81

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8
Q

Gas Exchange Depends on?

A

Open, Air-filled alveoli, intact alveolar-capillary membranes, and blood flow

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9
Q

Ventilation is impaired from?

A
  1. Decrease in lung compliance
  2. Increase in airway resistance
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10
Q

Lung compliance is reduced by?

A

stiffness of fluid-filled lungs - chest XR “pathy” or “ground glass”

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11
Q

What happens when Surfactant is lost?

A

Alveolar collapse

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12
Q

Mediator-induced bronchoconstriction restricts what?

A

Air Flow

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13
Q

Stage 1 ARDS assessment? 12hrs

A

Tachypnea, Dyspnea, Restlessness

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14
Q

Stage 1 Labs?

A

Respiratory Alkalosis

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15
Q

Stage 2 ARDS assessment? 24 hrs

A

Tachypnea, Severe Dyspnea, Increase Restlessness and Agitation, Tachycardia, Cyanosis, Crackles

“Mechanical Ventilation” at this point

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16
Q

Stage 2 Labs?

A

Decreased SaO2 despite Oxygen supplement
CXR- “patchy”
Increasing Acidosis

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17
Q

Stage 3 ARDS assessment? 2-10days

A

Decreased air entry, Impaired Responsiveness, Decreased gut motility, Generalized edema, Poor skin integrity

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18
Q

Stage 3 Labs?

A

ABG: worsening hypoxemia

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19
Q

Stage 4 ARDS assessment? >10 days

A

MODS, Decreased UOP, Impaired coagulation

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20
Q

Stage 4 Labs?

A

ABG: worsening hypoxemia and hypercapnia

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21
Q

Other late signs of ARDS?

A

Hypoxia, dysrhythmias, chest pain, decreased renal function, decreased bowel sounds

22
Q

CO decreases despite tachycardia b/c?

A

of inflammatory mediators, resulting in hypotension

23
Q

Hallmark of ARDS

A

Deterioration of ABGs
(despite interventions)

refractory hypoxemia
w/ persistently low SaO2

24
Q

What happens when ventilation becomes increasingly impaired?

A
  1. CO2 increases
  2. Lactate elevates form tissue hypoxia
  3. Anaerobic metabolism is induced from hypoxemia
    Results in mixed respiratory and metabolic ACIDOSIS
25
Q

Monitor lactate levels to ensure what?

A

adequate perfusion despite hypoxemia

26
Q

Body gets Adequate perfusion through what?

A
  1. Oxygen delivery
  2. Cardiac Output
  3. HgB
27
Q

What is an important test everyday for an ARDS patient?

A

Chest X-Ray

28
Q

Chest X-Ray shows what on ARDS pt?

A
  1. “patchy” infiltrates
  2. Consolidation
  3. Air Bronchograms
29
Q

Percentage of SHUNT in ARDS pt?

A

15%

30
Q

Shunt is associated with the level of?

A

Profound hypoxemia

31
Q

VAP “bundle”

A
  1. Elevate HOB 30%
  2. Daily weaning assess
  3. Daily Sedation withhold
  4. Weaning Protocol
  5. DVT prophylaxis
  6. PPI- peptic ulcer prophylaxis
32
Q

Sepsis “bundle”

A
  1. antibiotic
  2. fluid resuscitation
  3. steroids
  4. Protein C
  5. DVT prophylaxis 48hrs
  6. Peptic ulcer prophylaxis
33
Q

Other “bundle”

A
  1. Glucose control
  2. Post-pyloric feeding
  3. Subglottic suctioning
  4. Electrolyte replacement
34
Q

Inotropic agents used in ARDS?

A

dobutamine or milrinone
(enhance contractility and increase CO)

35
Q

Dobutamine may cause?

A

systemic vasodilation and hypotension

36
Q

Norepinephrine is a ?

A

Vasoconstrictor
(counteract vasodilation)

37
Q

Vasoconstrictors may do what to the lungs?

A

Constrict

38
Q

Vasoactive drugs require?

A

Arterial blood pressure monitoring

39
Q

Strategies for VILI (ventilator reduced lung injury)?

A
  1. Vt - tidal volume < 6mL/kg
  2. PEEP - 10-15 cm
  3. Sedation to prevent dyssynchrony
40
Q

Antibiotic therapy for ARDS?

A

Should not be used prophylactically, NEED CULTURE 1st

41
Q

Bronchodilators and Musolytics assist with?

A
  1. Maintaining airway patency
  2. Reducing inflammation
  3. Secretions
42
Q

IV corticosteroids are given in ?

A

Low doses

43
Q

Nitric Oxide is?

A

Inhaled and vasodilates the lungs - reduces pulmonary hypertension

44
Q

NMBA is used with?

A

propofol and require a sedation

45
Q

Nutritional requirements for ARDS?

A

35-45 kcal/kg/d and HIGH CARBs are avoided to prevent CO2 production

46
Q

ARD Outcomes?

A
  1. Patent airway maintained
  2. Lung- protection ventilation
  3. Risk for VAP, atelectasis, volutrauma REDUCED and O2 Improved
  4. O2 maximized
  5. BP, CO, CVP, Stable
  6. Patient euvolemic
  7. No evidence of Electrolyte imbalance or Renal dysfunction
  8. No evidence of bed rest or immobility complications - skin intact
  9. No evidence of Infection: WBC in normal limits
  10. Metabolic requirements
  11. VS stable, Pt comfortable, Decreased Anxiety
47
Q

Most serious development of a complication of ARDS?

A

MODS

48
Q

Considerations of Older Patients w/ ARDs?

A
  1. 65 or older are at increased risk for MODS and less chance of recovering
  2. Increased immunosuppression
  3. Hemodynamic instability
  4. Decreased stroke volume
  5. Decreased lung volume
  6. Decreased muscle mass
  7. General peripheral edema
  8. Decreased skin integrity
  9. Ageism
  10. Comorbid conditions
49
Q

How to prevent Volutrauma?

A

Lowest possible airway pressure, PEEP, and Vt

50
Q

Reduce VAP by?

A
  1. subglottic Suction
  2. nasal Suction
  3. oral care
  4. HOB 30
  5. feeding postpyloric
  6. repositioning

Respiratory (4 decks)

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