ARDS & CHF

Question 1

What diseases were chronic vs. acute in the ARDS patient?

Answer 1

Chronic: COPD, ESRF
Acute: Pneumonia

Question 2

What prescribed opioid caused a questioning of ARDS patient breathing ability?

Answer 2

Hydrocodone

Question 3

How do we treat acute chronic respiratory failure, with COPD along with pneumonia?

Answer 3

By treating them with antibiotics and SABA medication like Duoneb through a small-volume nebulizer to improve their work of breathing.

Question 4

What are one of the best management methods on the MV for ARDS? And what is the advantage of this?

Answer 4

Low tidal volume ventilation; PRVC due to being able to pressure limit while also delivering a set volume making it safer and less risky to avoid hyperinflation damage.

Question 5

What oxygen therapy is disregarded for ARDS standard of care?

Answer 5

Non-invasive ventilation

Question 6

What is NIV widely known as a therapy for?

Answer 6

Therapy for acute hypercapnic respiratory failure as a result of COPD exacerbations. Related to improvement in death rates.

Question 7

What is a first treatment option as an acceptable alternative for COPD patients who arrive with increased WOB and hypercapnic respiratory failure in the context of Covid-19?

Answer 7

Non-invasive ventilation

Question 8

What occurs when relatively minor, although often multiple, insults cause acute deterioration in a patient with chronic respiratory insufficiency?

Answer 8

Acute Chronic Respiratory Failure

Question 9

What condition occurs when the lungs can’t get enough oxygen into the blood or eliminate enough CO2 from the body?

Answer 9

Chronic Respiratory Insufficiency

Question 10

What is the development process of chronic respiratory failure? What about in regards pH?

Answer 10

It develops over many days, which allows time for the kidneys to increase blood bicarbonate concentration. Therefore, the pH usually is only slightly decreased. So the patient’s “chronic” part was chronic respiratory insufficiency.

Question 11

What causes most CHF?

Answer 11

Coronary artery disease

Question 12

What were John Hopkins University’s findings on CHF research?

Answer 12

-Diabetes & high BP put African Americans at risk of CHF.
-Diabetes & HPTN balance out, lowering risk.
A simple blood test may potentially identify people with a better prognosis following hospitalization.
-CHF patients with a cardiac stress-related protein were 57% more likely to return to the hospital.

Question 13

What damages smooth muscle over time and what does it affect?

Answer 13

Drug usage. It affects blood pressure and overall health.

Question 14

Which amphetamine induces CHF? Is it increasing or decreasing? Is the usage national or regional?

Answer 14

Methamphetamine
It is declining and usage remains regional.

Question 15

What helps prevent CHF? What influences ARDS, COPD and CHF?

Answer 15

Drug abstinence helps prevent CHF.
Lifestyle influences ARDS, COPD, and CHF.

Question 16

What lifestyle choices could induce hypertension, or cardiomyopathy, and CHF?

Answer 16

Smoking and heavily drinking.

Question 17

What ejection fraction percentage and below indicate CHF and what other failures?

Answer 17

Ejection fraction <40% and systolic/diastolic failures.

Question 18

What may be lifestyle effects findings in CHF individuals?

Answer 18

Due to smoking, or potential diabetes they may have excess adipose tissue from bad nutrition or lack of exercise.

Question 19

What could assist with heart rate in CHF?

Answer 19

A vasodilator or beta 2 blocker

Question 20

What could long-term methamphetamine usage cause?

Answer 20

Severe dilated cardiomyopathy, a disease in which the heart muscle enlarges and cannot pump enough blood. Heart failure may result.

Question 21

What could induce left-sided heart failure? What does an advanced form of left-sided failure result in?

Answer 21

Coronary artery disease, heart attack, or long-term high blood pressure commonly induce left-sided heart failure.
An advanced form causes right-sided heart failure.

Question 22

What is a normal EF?

Answer 22

50-75%

Question 23

What could overuse of methamphetamine result in?

Answer 23

Blood vessel spasms, which could cause severe BP to spike and cardiac electrical system rewiring.

Question 24

What are the two types of heart failure?

Answer 24

Systolic heart failure & Diastolic heart failure

Question 25

What is systolic heart failure? Which part of the heart does it take place in?

Answer 25

The left and right ventricles are the bottom chambers of the heart. In a person with systolic heart failure, the heart is weak, and the left ventricle can’t contract (squeeze) normally when the heart beats. Occurs in the heart’s left ventricle.

Question 26

What is diastolic heart failure?

Answer 26

It is when your heart can’t relax normally between beats. There is not enough blood to fill up the ventricles.

Question 27

*What is the expanded version of BERLIN DEFINITION for ARDS?

Answer 27

Timing.
A. Within 1 week of a known clinical insult or new or worsening respiratory symptoms
Chest imaging.
B. Bilateral opacities – not fully explained by effusions, lobar/lung collapse, or nodule
C. Respiratory failure not fully explained by cardiac failure or fluid overload
Origin of edema.
A. Need objective assessment (e.g., echocardiography) to exclude hydrostatic edema if no risk factor is present
Oxygenation.
A. Mild: 200 mmHg < PaO2/FiO2 <300 mmHg with PEEP or CPAP > 5 cmH2O
B. Moderate: 100 mmHg < PaO2/FiO2 < 200 mmHg with PEEP >5 cmH2O
C. Severe: PaO2/FIO2 <100 mmHg with PEEP >5 cmH2O

Question 28

*What was the problem with the berlin definition?

Answer 28

It offered no room for stratifying and identifying ARDS patients because there was no further re-evaluation of the hypoxemia under a standard ventilator setting in a specific period.

Question 29

*What was not mentioned in the Berlin definition of ARDS?

Answer 29

Acute Lung Injury (ALI)

Question 30

*What is the American-European Consensus Conference guidelines for ARDS? “ARDS NEW DEFINITION”

Answer 30

American-European Consensus Conference of ARDS definition:
1. Acute and sudden onset of severe respiratory distress
2. Bilateral infiltrates of frontal chest radiograph
3. The absence of left arterial hypertension (PCWP <18 mmHg or no clinical signs of left ventricular failure
4. Severe hypoxemia (assessed by the PaO2/FiO2 ratio)
ALI exists when PaO2/FiO2 ratio is <300 mmHg
ARDS exists when PaO2.FiO2 ratio is < 200 mmHg

Question 31

*Why was the American-European consensus conference of ARDS establishing new guidelines?

Answer 31

to properly classify the severity of patients with ARDS.

Question 32

*What is an option for CHF/COPD patients which is NOT for ARDS patients? Why is that?

Answer 32

Non-invasive ventilation
When CPAP is applied to pts with CHF it increases intrathoracic pressure because the positive pressure from CPAP makes the left ventricle work harder, the right ventricle works less, and CPAP lessens the gradient of flow and prevents blood from backing up into the lungs.