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÷ ©on-cardiac pulmonary edema
÷ Refractory hypoxemia
÷ PO2 <50, PCO2 >50, pH < 7.25
÷ Mortality rate is greater than 50%
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÷ GAspiration ÷ GSepsis
÷ GPneumonia ÷ GMassive trauma
÷ Chest trauma ÷ Acute pancreatitis
÷ Embolism ÷ Anaphylaxis
÷ Toxic inhalation
÷ Cardiopulmonary bypass
÷ ©ear-drowning
÷ Severe head injury
÷ O2 Toxicity
÷ Vascular: DIC, Massive
÷ Radiation pneumonitis
transfusions
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 ÷ Opioid drug overdose
 
   
÷ Systemic response, can occur within 24 hr
÷ Increased capillary permeability
÷ Due to damage from activated neutrophils
÷ Causes severe pulmonary edema
÷ Alveoli fill with fluid
÷ º surfactant production
÷ Causes decreased compliance
÷ Causes atelectasis
÷ Hyaline membranes form
÷ Causes decreased gas exchange
and compliance
÷ Fibrotic lung changes
÷ Leads to widespread fibrosis and scarring

 

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Œ. Injury or Exudative stage
2. Reparative or Proliferative stage
3. Fibrotic stage

 

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Œ. Injury or Exudative stage (Œ-7 days)
÷ Accumulation of fluid/protein lead to endothelial damage
÷ Inflammatory cells in response to the initial injury
2. Reparative or Proliferative stage (Œ-2 weeks)
÷ Continued inflammatory response
÷ Complete when lung composed of dense, fibrous tissue
3. Fibrotic stage (2-3 weeks)
÷ Lung completely remodeled by fibrous tissue
÷ Also called chronic or late phase
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÷ Dour patient is a 32 yo female hospitalized as a
result of a near-drowning. Upon assessment,
you suspect ARDS when you observe all of the
following except:
A. Tachypnea
B. Retractions
C. Clubbing
D. Cyanosis
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÷ Dour patient is a 32 yo female hospitalized as a
result of a near-drowning. Upon assessment,
you suspect ARDS when you observe all of the
following except:
A. Tachypnea
B. Retractions
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D. Cyanosis
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÷ Which of the following is ©OT an
appropriate method for managing ARDS?
A. ADH replacement therapy
B. Aggressive respiratory support w/PEEP
C. Surfactant replacement therapy
D. Sedation & positioning
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÷ Which of the following is ©OT a way to
manage ARDS?
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B. Aggressive respiratory support w/PEEP
C. Surfactant replacement therapy
D. Sedation & positioning
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÷ Dou note SOB, crackles throughout all lung
fields posteriorly and in both lower lobes
anteriorly, and rhonchi over the large
airways. What is the significance of crackles
in G.S.ǯs case?
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÷ The nurse from the previous shift charted
the following statement, DzCrackles and
rhonchi clear with vigorous coughing.dz
Based on your knowledge of
pathophysiology, is this statement accurate?
Why or why not?
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÷ Which complication affects 68% of patients
with ARDS?
A. Barotrauma
B. Volume pressure trauma
C. Pneumonia
D. Stress ulcers
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÷ Which complication affects 68% of patients
with ARDS?
A. Barotrauma
B. Volume pressure trauma
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D. Stress ulcers
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÷ What symptom of respiratory distress is this
baby exhibiting?
÷ http://www.youtube.com/watch?v=I6WvSD pqi8&featu
re=related
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÷ What adventitious lung sound are you
hearing?
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÷ Dou are about to administer 40mg
furosemide (Lasix) IVP. What effect, if any,
will furosemide have on G.S.ǯs breath
sounds?
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÷ ©ame at least two actions you should take
before you give furosemide to G.S.
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urimeter for increased accuracy
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÷ While you administer the furosemide, G.S. says,
DzThis is so weird. A couple times this morning, I
felt like my heart flipped upside down in my
chest, but now I feel like thereǯs a bird flopping
around in there.dz Prioritize your actions from the
following:
A. Call a Rapid Response Team code
B. Stop the infusion
C. Gather equipment for the code responders
D. Assess G.S.ǯs heart (rate, rhythm, etc.)
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÷ While you administer the furosemide, G.S. says,
DzThis is so weird. A couple times this morning, I
felt like my heart flipped upside down in my
chest, but now I feel like thereǯs a bird flopping
around in there.dz Prioritize your actions from the
following:
A. Call a Rapid Response Team code
B. Stop the infusion
C. Gather equipment for the code responders
D. Assess G.S.ǯs heart (rate, rhythm, etc.)
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÷ Which of these values are outside of the
normal range?
A. ©a: Œ29 mmol/L
B. K: 3.3 mmol/L
C. pH: 7.38
D. PaCO2: 49 mm Hg
E. HCO3: 36 mmol/L
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÷ Which of these values are outside of the
normal range?
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÷ Analyze G.S.ǯs ABGs:
÷ pH: 7.38
÷ PaO2: 82 mm Hg
÷ PaCO2: 49 mm Hg
÷ HCO3: 36 mmol/L
÷ BE: +2.2
÷ SaO2: 9Œ%
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  
÷ Dou open G.S.ǯs medication drawer to draw
the furosemide into a syringe. Dou find one
20 mg ampule. The pharmacist tells you
that it will be at least an hour before he can
send the drug to you. What should you do?
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÷ Priority is to help G.S. reduce the fluid in her
lungs to reduce breathing difficulty
÷ ©ote in G.S.ǯs chart that only 20 mg was given
and the remaining dose is to be given upon
its arrival from pharmacy
  

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÷ The major cause of death in ARDS is
, often accompanied by
.
A. SIRS (Systemic Inflammatory Response
Syndrome); shock
B. SIRS; sepsis
C. MODS (Multiple Organ Dysfunction
Syndrom); shock
D. MODS; sepsis
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÷ The major cause of death in ARDS is
, often accompanied by
.
A. SIRS (Systemic Inflammatory Response
Syndrome); shock
B. SIRS; sepsis
C. MODS (Multiple Organ Dysfunction
Syndrom); shock
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÷ Chen, D., Chou, S., Lin, L. & Wu, L. (2006). The effect of intermittent nasogastric feeding on prevention
aspiration pneumonia in ventilated critically ill patients. -
 

  
Œ4 (3), Œ67-Œ80.
÷ Curley, M. A. Q., Thompson, J. E., & Arnold, J. H. (2000). The Effects of Early and Repeated Prone
Positioning in Pediatric Patients With Acute Lung Injury. -
 
, ŒŒ8 (Œ), Œ56-Œ63.
÷ Deglin, J. H. & Vallerand, A. H. (2009). |
| 
  . Philadelphia, PA: F. A. Davis
Company.
÷ Lewis, S. L., Heitkemper, M. M., Dirksen, S. R., OǯBrien, P. G., & Bucher, L. (2007). 
 

  St. Louis, MO: Elsevier.
÷ Mailey, J., Digiovine, B., Bailod, D., Gnam, G., Jordan, J., & Rubinfeld, I. (2006). Reducing Hospital
Standardized Mortality Rate With Early Interventions. -
 



   Œ3 (4), Œ78-Œ82.
÷ Pagana, K. D., & Pagana, T. J. (2007).
|






 St. Louis, MO:
Elsevier.
÷ Schaffler, R. (2009). [ARDS lecture notes for Adult Health II]. Unpublished.
÷ Websites:
÷ www.medicinenet.com
÷ www.ards.org
÷ www.emedicinehealth.com/acute respiratory distress syndrome/article em.htm