ARDS

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Author:
alvo2234
ID:
246423
Filename:
ARDS
Updated:
2013-11-12 12:15:48
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Swan
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Description:
PT IV exam
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  1. what is the AECC definition of ARDS
    • acute hypoxemia with PaO2 /FiO2 ratio < 200
    • bilateral infiltrates on chest xray (pul edema)
    • PAWP of 18 mmHg or less
    • no evidence of left atrial hypertension
  2. what is the AECC definition of acute lung injury (ALI)
    milder respiratory distress (paO2/FiO2 ration <=300)
  3. timing for Berlin ARDS
    within 1 week of a known clinical insult or new or worsening repiratory sx
  4. Berlin mild, moderate, severe oxygenation
    • mild: 200 - 300
    • moderate: 100 - 200
    • severe: <100
  5. Berlin origin of edema
    respiratory faulure not fully explained by cardiac or fluid overload
  6. exudative stage timeframe and description
    • 1-4 days after onset of lung injury. marked by;
    • 1. rapid respiratory failure
    • 2. hypoxemia refractory to mech ventilation
    • 3. accumulation of excessive fluid, protein and inflm cells
  7. proliferative stage time frame and description
    • beginning at days 7-14. marked by;
    • 1. persistent hypoxemia
    • 2. histologic fibrosis present
  8. recovery phase timeframe and description
    • varies from 14 days up to 6-12 months post injury. characterized by;
    • 1. lung tissue reorganization and recovery
  9. what are the common causes of direct lung injury
    • pneumonia 
    • aspiration of gastric contents
  10. what are the common causes of indirect lung injury
    • sepsis 
    • severe trauma with shock and transfusions
  11. what are the tx strategies for ARDS
    • mechanical ventilation
    • fluid managemant (conservative)
  12. what are some of the complications of ventilation
    • VAP
    • increased risk for stress-related mucosal damage
    • delirium and altered mental status from sedation
  13. what are the two reasons for intubation
    • brain injury 
    • lung injury
  14. normal pH values
    7.35-7.45
  15. normal PaCO2 values
    35-45 mmHg
  16. normal PaO2 values
    90-100 mmHg
  17. normal base excess values
    -2 to 2 mEg/L
  18. what is the tidal volume
    volume of air
  19. what are the two things needed to improve oxygenation
    • FiO2
    • PEEP or mean airway pressure
  20. what are the three things needed to improve CO2 elimination
    • increase minute ventilation
    • increase respiratory rate
    • increase tidal volume
  21. what does MV equal
    tidal volume x respiratory rate
  22. what are the different modes of mechanical ventilation
    • CMV - regular time intervals of machine 
    •          volume control
    • A/C - negative inspiratory pressure triggers 
    •         the assist control breath
    • IMV - spontaneous breathing
  23. which type of ventilation pressure do humans breath with
    negative pressure ventilation
  24. which paralytic causes tachycardia
    pancuronium
  25. which NM blocker is ultra fast acting
    succinylcholine
  26. Train of four (TOF) results and actions
    • 1/4- decrease the dose
    • 2/4- continue on current regimen
    • 3-4/4- increase the dose
  27. vasodilators used for ARDS
    • NO
    • epoprostanol
  28. what are vasodilators indicated for in ARDS
    • pulmonary hypertension 
    • right sided heart dysfunction
  29. drugs available for pts on ECMO
    • bzd for sedation
    • fentanyl for pain
    • nicardipine for bp
    • heparin for clotting
    • vancomycin, gintamycin (abx)

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