Respiratory Failure/Respiratory Arrest

Question 1

ards

Answer 1

denotes acute hypoxemic respiratory failure following a systemic or pulmonary. insult w/o evidence of heart failure

Question 2

what is the FI o2 ratio in ards?

Answer 2

<200

Question 3

what are the main causes of ards

Answer 3

sepsis syndrome, severe muliple trauma, and aspiration of gastric contents

(others- shock, toxic inhalation, near-drowning, multiple transfusions)

Question 4

RF of ards

Answer 4

sepsis, aspriation of gastric contents, shock infxn, lung contusion, non-thoracic trauma, toxic inhalation,

1/3 of ards pts have sepsis syndrome

Question 5

ards pathogenesis

Answer 5

increases permeability of the alveolar capillary membranes, which leads to the development of protein-rich edema

pro-inflammatry cytokines released from stimulated inflammatory cells-pivotal in lung injury ** damage to capillary endothelial cells and alveolar epithelial cells is common to ARDS regardless of cuas–> interstitial and alveolar pulmonary edema, alveolar collapse, and hypoxemia

Question 6

CF of ards

Answer 6

o Rapid onset of profound dyspnea that usually occurs 12-48 hours after the initiating event.
o Labored breathing
o Tachypnea
o Frothy pink or red sputum
o Intercostal retractions
o Diffuse crackles
o ** A quiet chest, agitation or confusion are ominous signs of impending respiratory failure
o Many patients are cyanotic with increasingly severe hypoxemia that is refractory to administered oxygen

Question 7

dx of ards

Answer 7

CXR-normal at first, but then shows diffuse or patchy bilateral infiltrates that spare costrophrenic angles

air bronchograms-80%, upper lung zone venous engorgement is distinctly UNcommon.

heart size normal

multiple organ failur is common

Question 8

prevention of ards

Answer 8

nada. PEEP and I V methylprednisolones doesn’t prevent ards

Question 9

tx of ards

Answer 9

tx underlying cause
o Treatment of hypoxemia seen in ARDS usually requires tracheal intubation and positive pressure mechanical ventilation. Hypoxia is often refractory to treatment
o The lowest levels of PEEP and supplemental oxygen required to maintain PAO2 above 55 mmHg or the SaO2 above 88% should be use.
o Efforts should be made to decrease FIO2 to less than 60% as soon as possible in order to avoid oxygen toxicity.
o PEEP can be increased as needed as long as cardiac output and oxygen delivery do not decrease and airway pressures do not increase excessively.
o Prone position may transiently improve oxygenation in selected patients by helping recruit atelectatic alveoli; however, great care must be taken during the maneuver to avoid dislodging catheters and tubes.

Question 10

what is the most common cardiac failure, cardiac arrest?

Answer 10

ischemic heart dz

vtach and vfib