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13 Cards in this Set

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ARDS
rapid progressing, fulminating form of hypoxemic respiratory failure, often occurs in previously health persons who have sustained severe physciological insult
48-96 hours after event
high mortality rate
causes of ARDs
direct - pulmonary insults - pneumonia, aspiration, fat/air embolus, lung contusion, tuberculosis, inhaled toxins, chest trauma
indirect Isystemic)- shock, sepsis, pancreatitis, uremia, drug overdose, trauma, DIC, massive transfusion reactions
ARDS pathophys
acute lung injury - inflammatory/immune response - release of cellular mediators
stages of ARDS
injury/exudative statge
reparative/proliferative stage
fibrotic stage
injury/exudative stage
1) damage to pulmonary capillaries - increased permeabililty - fluids & proteins move into alveolar spaces (decreased compliance/hypoxia)
2) decreased surfactant production - alveoli collapse - atelectasis & decreased compliance
3) hyaline lines alveolar membrane - begins fibrosis formation - diffusion impairment begins and lungs are stiff, noncompliant
reparative/proliferative phase
lung tissue regenerates - dense fibrous tissue
alveolar membrane thickens (diffusion limited)
fibrotic phase
lungs completely remodeled - fibrous tissue is not compliant
ARDS clinical manifestations
tachypnea/dyspnea - accessory muscles
adventitous lung sounds (diffuse crackles)
refractory hypoxemia - hallmark sign
ABGs - o2 does not increase with therapy
cyanosis- late sign
CV sx
ventilator association pneumonia
good infection control to prevent
ventilator bundle protocol (elevated HOB, sedation vacation, peptic ulcer prophylaxis, venous thrombosis phrophylaxis)
barotrauma
overdistended alveoli rupture during mechanical ventilation (permissive hypercapnia - ventiilator with smaller tidal volume)
volutrauma
alveolar function - fluid and trauma in alveolar space
so vent with smaller tidal volume (permissive hypercapnia) or decrease PPV
stress ulcer
correct hypotension, shock, acidosids
give H2 receptro antagnosits, P pump inhibitor, carafate
refractory hypoxemia
hallmark sign - cannot get PaO2 up despite high flow oxygen therapy