Exam 1 - SIRS and ARDS

Question 1

Criteria for SIRS

Answer 1

Must satisfy two of the following:
Temp greater than 38 degrees C or less than 36 degrees C
Heart rate greater than 90 bpm
Resp rate greater than 20 or PACO2 less than 32 mmHg
WBC greater than 12,000/mm or less than 4,000/mm or greater than 10% immature band forms

Question 2

• Systemic inflammatory response to a variety of insults. Initiating events include infection, ischemia, infarct, and injury.
• Overreactive immune response that affects the lungs first – occurs at the cellular level

Answer 2

SIRS

Question 3

What can SIRS lead to?

Answer 3

ARDs

Question 4

• Severe expression of acute lung injury; complication of disease processes
• Caused by direct or indirect pulmonary injuries

Answer 4

ARDS

Question 5

What happens in ARDS?

Answer 5

• Inflammation cause stiffening of lungs. The pt tries to breathe harder and becomes anxious which causes more histamines to be released. Eventually, alveolar collapse occurs.

Question 6

SX of ARDs

Answer 6

o Rapid onset of severe dyspnea
o Hypoxemia that does not respond to supplemental oxygen
• ABGs show increasing hypoxemia
o PAWP (measured with a Swann) <18 suggests ARDS
o BAL fluid is protein rich and contains inflammatory cells
o Cyanosis
o Cough
o Increasing use of accessory muscles
o Pulmonary function tests show increasing pulmonary restriction
o Temperature of 100.4

Question 7

How to manage ARDS

Answer 7

• Intubate immediately & mechanical ventilation with PEEP to treat progressive hypoxemia
• Positioning – frequent position changes, Rotoprone bed
• Nutritional support