ARDS & Oxygenation Flashcards
What does ARDS stand for?
Acute respiratory distress syndrome
Definition of ARDS?
Respiratory failure second to pulmonary or systemic insult without evidence of heart failure
Onset of ARDS?
Generally 12-48hrs but up to 1 wk of trigger
Causes of ARDS?
MC: Sepsis, aspiration/inhalation of harmful substances, burns, trauma, pneumonia, intubation
Other: OD, high altitude sickness, multiple transfusions, DIC, pancreatitis
Pathophys of ARDS?
Damage to capillary and alveolar endothelial cells d/t increased vascular permeability and diminished surfactant —> pulmonary edema & alveolar collapse causing hypoxemia
Characteristics of ARDS?
Rapid onset dyspnea (tachypnea, retractions), crackles, abnormal CXR, hypoxemia refractory to O2, shock can develop
CXR for ARDS?
Diffuse bilateral patchy infiltrates (air bronchograms)
-venus congestion, cardiomegaly, pleural effusion uncommon
Treatment for ARDS?
aggressive dx & tx of underlying disorder, usually intubation needed/adjustments to ventilator to avoid O2 toxicities
-supportive tx: fluids, fever control
Are there any preventative measures for ARDS?
None identified
Is steroid therapy effective for ARDS?
Not proven
Mortality rate of ARDS?
30-40% (90% if secondary to sepsis)
If ARDS patients survive, they will have some degree of _______ _________
chronic symptoms
What is a cricothyrotomy?
Emergency surgical airway (incision made between thyroid cartilage and cricoid cartilage)
Indications for a cricothyrotomy?
Unable to intubate or maintain oxygenation w/ bagging, severe facial trauma
Relative C/I of cricothyrotomy?
<12 y/o, obliteration of landmarks, coagulopathy
Alternative to cricothyrotomy?
Needle cricothyrotomy w/ transtracheal jet ventilation
Indications for needle cricothyrotomy w/ transtracheal jet ventilation?
Acceptable in peds, safer in coagulopathy
Does needle cricothyrotomy w/ transtracheal jet ventilation protect the airway?
No
What does needle cricothyrotomy w/ transtracheal jet ventilation require?
Clear upper airway passages and oral/nasal airway devices
Procedure diagram
What is the importance of pre-oxygenation?
Extends the duration of safe apnea
What is safe apnea defined as?
The time until a patient reaches a saturation level of 88% to 90%
Process of pre-oxygenation?
De-nitrogenating residual capacity of the lungs to maximize O2 storage w/in the lungs
In a patient breathing room air before rapid sequence tracheal intubation (PaO2 90-100) desaturation will occur in how long between sedative/paralytic administration and airway placement (and how it can change with pre-oxygenation)?
in the 45-60 seconds between the two
*3 min HIGH FLOW O2 (NC+NRB) WILL INC TIME UP TO 8 min