NRD/ ARD Flashcards
What characterises Acute Respiratory Distress Syndrome (ARDS)?
Non-cardiogenic pulmonary edema and diffuse lung inflammation
What are the causes of pulmonary ARDS?
Chest sepsis
Aspiration
Inhalation injury
Pulmonary contusion
Transfusion-related lung injury
What are the mechanisms underlying ARDS?
ARDS involves a V/Q mismatch where lung regions fail to ventilate properly (but still perfuse) due to injury, such as sepsis, trauma, or pneumonia.
Describe the symptoms of ARDS
Rapid-onset respiratory failure
Unresponsive to supplemental oxygen
Severe dyspnea
Confusion
Presyncope
Describe the signs of ARDS
An elevated respiratory rate
Bilateral lung crackles without heart failure features
Low SpO2
What diagnostic procedures are typically employed for ARDS?
(1) Arterial blood gas analysis (ABGs)
(2) Chest X-ray revealing bilateral alveolar infiltrates devoid of heart failure indicators
How is ARDS typically managed?
Oxygen therapy and mechanical ventilation, with emphasis on low tidal volume for improved outcomes.
What is the primary cause of Respiratory Distress Syndrome in newborns?
Premature infants are deficient in surfactant, leading to increased effort in expanding the lungs, which damages cells
Describe the pathophysiology of Respiratory Distress Syndrome in newborns
Strenuous inspiratory attempts to overcome high surface tension in the lungs.
This increased effort damages cells, including blood vessels, leading to fluid leakage into the alveoli
How is the Respiratory Distress Syndrome of the Newborn managed?
Oxygen therapy and mechanical ventilation to support breathing.
Explain chronic lung disease
Chronic Lung Disease characterized by;
(1) Oxygen requirement beyond 36 weeks
(2) Corrected gestation and evidence of parenchymal disease on CXR.
(3) High risk of RSV
(4) Wheezing, abnormal airways, growth and development issues
What are the complications associated with Respiratory Distress Syndrome of the Newborn?
Chronic Lung Disease
Transient Tachypnoea of newborn
Explain Transient Tachypnoea of newborn
Often caused by infection
What is Transient Tachypnoea of the Newborn and what is its common cause?
Caused by infection and presents with rapid breathing in newborns
Infants born before 34 weeks gestation are considered premature and are at a higher risk of developing what?
NRDS
An infant is born at 30 weeks gestation with tachypnea, central cyanosis, and flaring of the nostrils with each breath. Which of the following is most likely responsible for the infant’s symptoms?
Insufficient secretion of type II alveolar cells
A 45 year old male patient presents to the emergency department with epigastric pain and vomiting.
He drinks a bottle of vodka per day. His lipase level is 1000 U/L. He is managed appropriately and transferred to HDU. At the morning ward round the patient looks unwell.
His vital signs are: heart rate 90 bpm, respiratory rate 24/minute, blood pressure 110/85mmHg, temperature 36.9’C, oxygen saturations 90% which do not improve with 5L/min of oxygen via simple facemask.
Chest X-ray reveals bilateral infiltrates and a normal-sized cardiac silhouette.
Which of the following pathological features is consistent with the complication this patient has developed?
Diffuse alveolar damage with hyaline membrane formation
How to recongnise NRDS
<1 week onset of a known risk factor; pulmonary oedema, non-cardiogenic; pO2/FiO2 <40.
SIGNS AND SYMPTOMS of NRD
Rapid, labored breathing
Flaring nostrils
Grunting sounds during exhalation
Indrawing of the chest wall
Bluish discolouration of the skin due to low oxygen (cyanosis)
A 44 year old man experiences severe epigastric pain which is improved upon leaning forward. He had had an ERCP (Endoscopic Retrograde Cholangiopancreatography) 2 days prior. He is started on treatment. 2 days after this, he has progressive shortness of breath; bilateral crackles are heard on auscultation and CXR shows bilateral alveolar opacities throughout the lung fields. His O2 saturations dip and he is mechanically ventilated through an endotracheal tube, but passes away a few days later. His autopsy results show ‘hyaline membrane formation’ in the lungs. What would have improved mortality in this patient?
Low tidal volume
When do ARDS usually start?
12 - 48 hours after the initial insult with shortness of breath (dyspnea on exertion followed by dyspnea at rest) and hypoxia
