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Pulmonology > ARDS - Muthiah (Good, Good) > Flashcards

ARDS - Muthiah (Good, Good) Flashcards

1
Q 
What is the definition of ARDS w/ regards to 
1 - onset 
2 - type of damage
3 - type of edema 
4 - infiltrates
A

1 - acute, severe
2 - diffuse alveolar damage
3 - microvascular permability leading to non-cardiogenic pulmonary edema
4 - BILATERAL infiltrates

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2
Q

is ARDS responsive or refractory to O2? (hypoxemia)

A

ARDS is an acute refractory hypoxemia

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3
Q

is ARDS a VQ mismatch or shunt?

A

shunt

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4
Q

ARDS - What are the 4 Berlin Criteria

Must Know

A

1 - acute onset of respiratory failure
2 - bilateral infiltrates on CXR
3 - NO evidence of volume overload
4 - PaO2/FiO2 less than 300

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5
Q

what type of leukocytes should predominate in a bronchial alveolar lavage of normal pt?

A

macrophages

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6
Q

bronchial alveolar lavage of ARDS pt will see predominantly what type of leukocyte?

A

neutrophils - ARDS mechanism of lung injury is an inflammatory process - exudate containing neutrophils filling alveoli

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7
Q

what is the actual barrier to diffusion in ARDS? What causes it

A

hyaline membrane - caused by influx of protein rich edema fluid and inflammatory cells into air spaces

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8
Q

what causes alveolar collapse in ARDS?

A

inflammatory damage to type II pneumocytes causes dysfunction of surfactant - collapses of alveoli

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9
Q

what are the 5 direct causes of ARDS?

A

1 - pneumonia / aspiration of gastric contents or other causes of chemical pneumonitis
2 - pulmonary contusion, penetrating lung injury
3 - fat emboli
4 - near drowning
5 - inhalation injury

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10
Q

What is the link between sepsis and ARDS? What is the pathophys behind a pt with sepsis developing ARDS?

A

inflammation can spread via cytokines, and 100% of blood goes through pulmonary circulation

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11
Q

What are the 7 indirect causes of ARDS?

number 1 and 5 are key to know

A

1 - sepsis
2 - severe trauma w/ shock hypoperfusion
3 - drug over dose
4 - cardiopulmonary bypass
5 - acute pancreatitis
6 - transfusion of blood products
7 TRALI - transfusion related acute lung injury

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12
Q

where does the excess lung fluid consolidate (dorsal or ventral) and why

A

it consolidates dorsally due to the effects of gravity (the dependent portion of the lung is dorsal)

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13
Q

consolidation of lung fluid dorsally - what does this mean in terms of V/Q ratio

A

the dorsal portion of lungs, again b/c gravity, have most blood flow but least amount of ventilation (b/c of shunt) - this is why putting pt prone helps so much

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14
Q

if you put in an endotracheal tube, what relationship should it have to the carina? (he said we might be asked about this)

A

the tip of the endotracheal tube should be 1 - 1.5 inches above the carina

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15
Q

what are the 4 predictors of bad outcome for ARDS? (increased risk of death in ARDS) - this was on his USMLE

A

1 - chronic liver disease
2 - non-pulmonary organ dysfunction
3 - sepsis
4 - advanced age

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16
Q

(clicker) - pt with pneumonia is undergoing mechanical ventialtion following onset of ARDS - currently on 100% osygen, and PEEP of 5, but his O2 sat is only 75% - how do we inc his sat?

A

inc the PEEP

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17
Q

why do you not want to inc the tidal volume in a pt w/ ARDS who has low sat?

A

inc tidal volume will cause more stretching of alveolar cells, and the more stretching will cause more inflammation

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18
Q

what is the possible mechanism of improvement in oxygenation with the application of PEEP in pts with ARDS? (clicker)

A

recruiting atelectatic alveoli and increasing FRC - PEEP provides more “back pressure” during exhalation, helps to keep airways and alveoli open during exhalation

19
Q

what is the other potential mechanism of imporvement in ARDS by inc PEEP, specifically w/ regards to lung water?

A

inc PEEP causes a redistribution (NOT reduction) of lung water

20
Q

what is the importance of FRC when applied to holding ones breath or during the process fo intubation

A

the higher the FRC, the longer you can maintain a high O2 sat. pts w/ low FRC - pregnant ladies or obese pts - during intubation their sats will drop quickly

21
Q

ARDS is characterized by what change in pulmonary compliance?

A

acute decrease in pulmonary compliance

22
Q

he had another clicker about dec the tidal volume for ARDS, and how it showed a reduction in mortality

A

he says will be on boards -

23
Q

when is the incidence of penumothorax as a complication of ARDS usually seen?

A

After 2 weeks of ARDS onset (need to know)

24
Q

death in a patient due to ARDS is uaully a result of

A

multi-organ failure

25
Q

the severe hypoxemia seen in ARDS does not adequately respond to supplemental oxygen, signifying the main mechanism of hypoxemia to be

A

shunt (must know, will be on step)

26
Q

what is the central pathogenic mechanism of ARDS?

A

raging inflammation

27
Q

given that the central pathogenic mech of ARDS is raging inflammation, what possible pharmacological management does he mention that he uses, but is controversial?

A

corticosteroids

28
Q

USMLE: ARDS what type of respiratory failure, acute or insidious?

A

acute

29
Q

USMLE: pathogenic mechanism of ARDS

A

intense inflammation

30
Q

USMLE: common precipitating causes of ARDS (4)

A

pneumonia
sepsis
trauma
aspiration

31
Q

USMLE: what type of pulmonary edema is present in ARDS

A

non-cardiogenic

32
Q

USMLE: what is the mechanism causing severe hypoxemia seen in ARDS

A

shunt

33
Q

USMLE: ARDS is associated with what change in lung compliance

A

decreased lung compliance

34
Q

USMLE: what management strategy is used with mechanical ventilation to improve oxygenation

A

PEEP

35
Q

USMLE: how does PEEP help improve oxygenation in ARDS

A

recruits atelectatic alveoli and increases FRC

36
Q

USMLE: what is the mortality rate for ARDS?

A

30-40%

37
Q

USMLE: what is most common COD for ARDS

A

pts w/ ARDS die from multi organ failure

38
Q

USMLE: when do you see pneumothorax in ARDS

A

seen after 2nd week of onset of ARDS

39
Q

USMLE: what management strategy used during mechanical ventilation reduces mortality?

A

lower tidal volume

40
Q

USMLE: what management strategy will decrease the number of days on a mechanical ventilator?

A

conservative fluid management

41
Q

USMLE: survivors of ARDS have what ventilatory defect and what change in DLCO

A

mild to moderate restrictive ventilatory defect

mild reduction in DLCO

42
Q

USMLE: what recent trial for management strategy was shown to improve mortality of ARDS - ventilation strategy

A

prone ventilation

43
Q

USMLE: what management strategy helps to improve oxygenation but does not improve mortality at the current time

A

nitric oxide

Pulmonology (31 decks)

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