Critical Care Flashcards
What is ARDS?
Acute Respiratory Distress Syndrome
also known as Acute Lung Injury
Reaction of the lungs to direct and indirect injury (usually sepsis)
What are the features of ARDS?
Respiratory distress
Stiff lungs (requiring high inhalation pressures)
New pulmonary infiltrates on chest radiograph - PULMONARY OEDEMA w/o cardiac cause
No apparent cause of pulmonary oedema (pulmonary obstruction pressure <18mmHg)
Gas exchange problems
Pleural effusions also common
What percentage of patients with sepsis will develop ARDS? Why is it concerning?
20-40%
It is concerning in and of itself but also is considered as a warning factor for later MSOF
What happens to pulmonary pressures during ARDS?
There is often a pulmonary hypertension that can lead to right ventricular failure
Why do the lungs become stiff in ARDS?
Within days of the lung injury fibroblasts start to collect within the lung tissue leading to lung fibrosis
How does ARDS present clinically?
Tachypnoea
Hypoxaemia and central cyanosis
FINE CRACKLES (particularly at lung bases)
How should ARDS be managed?
Artificial ventilation Fluid restriction Use of diuretics Haemofiltration Change in position Inhaled NO
What is the difference between T1RF and T2RF?
Type 1 - hypoxaemia
Type 2 - hypoxaemia with co2 retention
What are some cause of T1 and T2RF?
T1 - Asthma attacks, cariogenic pulmonary oedema, acute lung injury, lung fibrosis
T2 - COPD (change in ventilatory shift) + reps wall weakness (Guillain Barré)
What are some clinical features that someone might be in resp failure?
Remember lots of these are also consequences of their conditions that have caused the RF
Tachypnoea, Dyspnoea, incr RR, Cyanosis, Accessory muscle use, tripoding, IC recession, pulses paradoxus, Agitation
What is classed as acute and severe resp failure?
RR > 40, unable to speak, exhausted, confused
