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32 Cards in this Set
- Front
- Back
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Whats pathophys of ARDS?
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Pro inflammatory cytokines leading to increased alveolar capillary permeability
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What’s left atrial pressure in ARDS?
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Normal; (? PCWP < 20)
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What ratio of PaO2/FiO2 defines ARDS vs AlI?
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Ratio < 300 in ALI
Ratio < 200 in ARDS |
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What are lung protective strategies w/ ventilation wen dealing w/ ARDS
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Low tidal voluems: 6 ml/kg
Plateau insp pressure < 30 cm H20 that improve outcomes |
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What does xray of ARDS show?
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Pulmonary edema/effusions, diffuse b/l alveolar opacity
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What’s pulm artery wedge in ARDS or ALI?
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< 18
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Whats pathophys of ards in alveolar damage?
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Interstitial and alveolar fluid – filled w/ protein, blood; from increased permeailtiy of alveolar-capillary barrier w endothelial and alveolar epithelial injry; hyaline membranes form
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How does epithelial injury occur?
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Epithelial injury impedes removal of alveolar fliud via decreased activity of epithelial sodium channes (ENaC) and disruption of surfactant productiona\ dn turnover; also get influx of acute inflammatory cells (neutrophils)
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Whats ARDS hallmark?
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Type II cell heyperplasai: repair mechanism**
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what pro-inflamm cytokines are increased/released in ARDS?
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Activated macrophages and TNF, IL1, 6,8, macrophage inhib factor
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What anti-inflamm cytokines are balanced w/ pro-inflam cytokines?
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Soluble TNF recptor; IL-receptor antag; IL-8 autoab; IL 10, IL 11
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Theres a change in what cell surface adhesion molecules on?
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endothelium (E-selectins); leukoctyes (L-selectings; and plateltes (P-selectins)
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Which molecules tell neutrophils where to stop?
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L-selectins
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ARDS can occur in what kind of patients?
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Neutropenic pts
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During ARDS what do neutrophils release?
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Ocidants, proteases, leukotrines, platelet activating factor (PAF
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What leads to infactiviation of surfactant?
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Influx of protein ricH edema fliud into alveolus
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When does ARDS present?
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Within 72 hours of acute injury but may be up to 1 wk
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What does PEEP do in ARDS?
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Improves oxygenation by alveolar recruitment and raised mean airway pressure; improves lung compliance and airway resistance by shifting up FRC AND decreases pulm vasc resistance
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How does fresh water drowning affect lung?
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Disrupts surfactant system w/ alveolar instaibllity and atelectasis
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How does salt water drowning affect lung?
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Hypertonicity draws water into alveoli w/ dilution of surfact;
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How does drowning affect lugns?
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Pulmonary dysfx: injury to alveolar-capillary barrier w/ prtoeinaceous non hydrostatic pulmonary edema ;may lead to ARDS
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Whats best treatment in drowning?
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Early PEEP to reverse hypoxemia
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What’s poor prognosis for near drowning?
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CPR > 25 in; CPR at hospital; fixed, dilated pupuils; sz; flaccid; GCS < 5
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What kind of injury causes total respiratory muscle paralysis?
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Above C-3
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What is diaphragm innerved by ?
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C 3,4,5 (keep diaphragm alive)
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Nerves to diaphra and scalen muscles are from what ? and involved in inspiration
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C3-8
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Nerves to expiraotyr muscles are where?
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Below C8
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What increases oxygenation in ards w/o decreasing total lung water content?
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PEEP
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What are causes of ARDS?
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Sepsis, aspiration, pna, severe trauma; massive transfusion
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Patient w/ rapidly developing tacky, hypoxemia w/ cyanosis, inspiratory crackels; hazy cxr has what?
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Most likely ARDS
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What are 3 main mechanisms that prevent alveolar edema?
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Intravascular proteins; interstitial lymphatics (return large volume of fluids to lymphatics); and tight jxn (b/w alveolar cells) which prevent leakage
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What inflamm mediators are released w/ alveolar damage?
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TNF alpha; IL 1, 6,8
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