PostOp

Question 1

PostOp Hypoxia: DDx

Answer 1

Obstruction
Bronchospasm
Respiratory Depression (opioid narcosis)
Aspiration
Atelectasis
PE

Question 2

PostOp Bilateral Diffuse Infilatrate DDx

Answer 2

Aspiration
Pulmonary edema (cariogenic, neurogenic)
ARDS
Transfusion rxn (TACO, TRALI)

Question 3

ARDS Diagnosis

Answer 3

Berlin Definition

1. PaO2/FiO2 <300
2. Acute onset
3. Bilateral infiltrates
4. Respiratory failure not explained by heart failure or fluid overload

*Pulmonary manifestation of SIRS (injury to capillary alveolar membrane resulting in infiltrates, dyspnea, hypoxemia)

Question 4

ARDS Treatment

Answer 4

Aggressively treat causative events and reversible pathology

Supportive mechanical ventilation
     Sufficient PEEP
     TV 6 mL/kg
     Plateau pressure <30
     FiO2 <50

(Steroids increase mortality in early ARDS)