FN: ARDS

Question 1

Pathogenesis

Answer 1

􏰀 May result from direct pulmonary insult or be 2O to severe systemic illness.
􏰀 Inflam mediators → ↑ capillary permeability and non- cardiogenic pulmonary oedema.

Question 2

Clinical FEatures

Answer 2

􏰀 Tachypnoea
􏰀 Cyanosis
􏰀 Bilateral fine creps
􏰀 SIRS

Question 3

Ix

Answer 3

􏰀 Bloods: FBC, U+E, LFTs, clotting, amylase, CRP,
cultures, ABG.
􏰀 CXR: bilateral perihilar infiltrates

Question 4

Dx

Answer 4

􏰀 Acute onset
􏰀 CXR shows bilateral infiltrates
􏰀 No evidence of congestive cardiac failure
􏰀 PaO2:FiO2

Question 5

Mx

Answer 5

Admit to ITU fororgan support and Rx underlying cause

Question 6

Ventilation
Indications
Method
SEs

Answer 6

􏰀 Indications
􏰁 PaO26KPa
􏰀 Method
􏰁 6ml/kg + PEEP (e.g. 10cm H2O)
􏰀 SEs
􏰁 VILI
􏰁 VAP
􏰁 Weaning difficulty

Question 7

Circulation Mx

Answer 7

􏰀 Invasive BP monitoring
􏰀 Maintain CO and DO2 ̄c inotropes
􏰁 E.g. norad or dobutamine
􏰀 RF may require haemofiltration

Question 8

Sepsis Mx

Answer 8

Abx

Question 9

Other Mx

Answer 9

Nutritional support: enteral (best), TPN

Question 10

Prognosis

Answer 10

50-75% mortality

Question 11

Causes

Pulmonary

Answer 11

􏰀 Pneumonia
􏰀 Aspiration
􏰀 Inhalation injury 􏰀 Contusion

Question 12

Causes systemic

Answer 12

􏰀 Shock
􏰀 Sepsis
􏰀 Trauma
􏰀 Haemorrhage and multiple transfusions
􏰀 Pancrea0titis
􏰀 Acute liver failure
􏰀 DIC
􏰀 Obs: eclampsia, amniotic embolism
􏰀 Drugs: aspirin, heroin

Question 13

Differential dx of Pulmonary Oedema Transudates Increase capillary hydrostatic pressure

Answer 13

􏰁 CCF
􏰁 Iatrogenic fluid overload
􏰁 Renal failure
􏰁 Relative ↑ in negative pressure pulmonary
oedema

Question 14

Transusdates reduced capillary oncotic pressure

Answer 14

􏰁 Liver failure
􏰁 Nephrotic syndrome
􏰁 Malnutrition, malabsorption, protein-losing
enteropathy

Question 15

Tranusdates increased interstitial pressure

Answer 15

reduced lymphatic drainage e.g. Ca

Question 16

Exudates differential

Answer 16

ARDs