ARF, ARDS, PE, Chest Trauma

Question 1

ARF extrapulmonary

Answer 1

Chemical depression
Opioid analgesics, sedatives, post-op anesthesia depression

Massive obesity
Chest trauma
kyphoscoliosis

Question 2

ARF intrapulmonary

Answer 2

lung itself has a disease

-airway dz: COPD, asthma

• PE, pneumothorax
• ARDS, near-drowning, inhalation injuries

Question 3

air movement inadequate/perfusion ok

Answer 3

ventilatory failure

Question 4

ABGs:
PaCO2 > 45 AND pH < 7.35
SaO2 < 90%

(respiratory acidosis)

Answer 4

ventilatory failure

Question 5

Musculoskeletal or anatomical lung dysfunction or suppression

Airway pressure does not change enough to allow air movement in and out of lungs

Answer 5

ventilatory failure

Question 6

air movement adequate

perfusion is DECREASED

Answer 6

oxygenation failure

Question 7

PaO2 < 60 mm Hg
SaO2 < 90%

PaCO2 34-45 (normal)

Answer 7

oxygenation failure

Question 8

due to breakdown of O2 transport from the alveolus to the arterial flow

Answer 8

oxygenation failure

Question 9

Injury to the pulmonary vasculature or the airways which results in noncardiac pulmonary edema and disruption of the alveolar-capillary membrane.

Answer 9

acute respiratory distress syndrome (ARDS)

-primarily an oxygenation problem

Question 10

4 phases of ARDS

Answer 10

1. exudative phase
2. Fibroproliferative phase
3. resolution phase
4. late or common ARDS

Question 11

exudative phase of ARDS

Answer 11

First 72 hours after injury

Mediators are causing injury
to pulmonary capillaries
Increased capillary membrane permeability

Development of microemboli
Increased pulmonary pressures, but PAOP can remain low or normal

Results in interstitial edema, alveolar edema

Type I and Type II cells are damaged, leading to alveolar collapse

Question 12

fibroproliferative phase of ARDS (2nd stage)

Answer 12

Disordered healing begins

Cellular granulation, collagen deposition

Fibrotic alveoli, pulmonary capillaries scarred

Increased stiffening and increased pulmonary HTN

Question 13

resolution phase (3rd phase of ARDS)

Answer 13

Resolution phase
Structural and vascular remodeling
Restoration of the alveolus
Macrophages remove debri
Type II cells multiply & some convert to Type I

Question 14

4th phase of ARDS

Answer 14

Permanent lung damage common
Problems may include cough, limited exercise tolerance and fatigue.
Anxiety, depression and flashback memories of their critical illness

Question 15

Severe dyspnea, using accessory muscles

Dry cough

Altered LOC, restlessness, anxiety, confusion

Lung expansion reduced

Vocal fremitus increased
-Increased density from diffuse pulmonary edema

Bronchiovesicular BS over most lung fields

Adventitious sounds-diffuse crackles over all lung fields

Answer 15

S/S of ARDS

Question 16

mild oxygenation

Answer 16

PaO2/FiO2

200-300

Question 17

moderate oxygenation

Answer 17

PaO2/FiO2

100-200

Question 18

severe oxygenation

Answer 18

PaO2/FiO2

<100

Question 19

Bits of thrombi occlude pulmonary artery

Lung ventilated but not perfused

DVT’s Iliofemoral System

Answer 19

Pulmonary embolism (PE)

Question 20

perfusion without ventilation

Answer 20

V/Q <0.8

Question 21

ventilation without perfusion

Answer 21

V/Q >0.8

Question 22

Conditions that result in extraalveolar air accumulation

pneumothorax
tension pneumothorax
hemothorax

Answer 22

air leak disorders

Question 23

Air in the pleural space that causes lung collapse

Answer 23

Pneumothorax

Question 24

Air enters in the pleural space via a one-way valve and is unable to exit

Answer 24

Tension pneumothorax

Question 25

An accumulation of blood in the pleural space

Answer 25

Hemothorax