Test 4 - Ch. 28 ARDS Flashcards
In gross appearance the lungs of patients with ARDS are _________________.
Heavy and “red”, “beefy” or “liverlike”
What are the major pathologic or structural changes associated with ARDS?
- Interstitial and intraavleolar edema and hemorrhage
- Alveolar consolidation
- Intraalveolar hyaline membrane formation
- Pulmonary surfactant deficiency or qualitative abnormality
- Atelectasis
As the ARDS disease progresses, the intraalveolar walls become lines with thick, rippled ____________.
Hyaline membrane
Historically, ARDS was first referred to as what?
The “shock lung syndrome” when the disease was first identified in the combat casualties during WWII.
ARDS accounts for ______% of all ICU admissions and ______ of patients on mechanical ventilation.
ARDS accounts for 10-15% of all ICU admissions and about 25% of patients on mechanical ventilation.
What are the most common causes of ARDS?
- Sepsis
- Aspiration
- Pneumonia
- Severe trauma
- Drug abuse
- Massive blood transfusion
- Massive traumatic tissue injury
- Fat embolism from a long-bone fracture
- Bilateral lung contusion
The clinical manifestations associated with ARDS usually appear within ________ of an inciting event and worsen rapidly.
6-72 hours
Berlin Definition of Mild ARDS
PaO2/FiO2 >200, but less than or equal to 300
Berlin Definition of Moderate ARDS
PaO2/FiO2 >100, but less than or equal to 200
Berlin Definition of Severe ARDS
PaO2/FiO2 less than or equal to 100
ARDS: Physical Examination
- Increased RR
- Increased HR and BP
- Substernal and intercostal retractions
- Cyanosis
- Dull percussion note
- Bronchial breath sounds
- Crackles
ARDS: Radiologic Findings
- Increased opacities, diffusely throughout the lungs
Which disease process would show a “ground-glass” and “honey comb” appearance on a CXR?
ARDS
What are some common complications of ARDS?
- Barotrauma
- Volutrauma
- Delirium
- DVT
- GI bleeding attributable to stress ulceration
- Pneumonia
What type of pneumonia is commonly associated with ARDS?
- Streptococcus pneumoniae
__________________ significantly reduce the rate of treatment failure both early and late based on radiographic progression and late septic shock.
IV corticosteroids
If the Pplat drops below 25 cm H2O, what is the most common protocol?
Increase tidal volume
For ARDS patients, their RR should not exceed ____ breaths/min
35
Normal PaO2/FiO2
Above 400
What is the protocol for ARDS?
- Low tidal volume
- High RR
- High PEEP
What is the most common cause of ARDS?
Sepsis
