Pulm Vascular Disorder: Acute Respiratory Distress Syndrome

Question 1

What is Acute Respiratory Distress Syndrome (ARDS)?

Answer 1

severe, progressive alveolar and capillary damage

Question 2

ARDS is associated with ____ lungs or _____- _______ lungs

Answer 2

wet

post-traumatic

Question 3

What is the onset? Happens ______ without much _______.

Answer 3

acute

quickly

warning

Question 4

What is the prognosis like?

Answer 4

High loss of life

Question 5

What is the mortality rate?

Answer 5

35-60%

Question 6

Etiology of ARDS (4)

Answer 6

1. Aspiration: anything but air in lungs eg water, smoke fire, gastric content etc
2. Near of drowning: inhaling H20
3. increase smoke inhalation
4. severe burns: not direct link

Question 7

Chart 29.2 Conditions which ARDS develop

Answer 7

ASPIRATION:

1. near drowning
2. aspiration gastric content

DRUGS, TOXIN, THERAPEUTIC AGENTS:

1. free base cocaine smoke
2. heroin
3. inhaled gases
4. breathing high concentration of O2
5. radiation

INFECTIONS:
1. septicemia

TRAUMA AND SHOCK:

1. burns
2. fat embolism
3. chest trauma

DISSEMINATED INTRAVASCUALR COAGULATION

MULTIPLE BLOOD TRANSFUSION

Question 8

Lungs in ARDS are ____ and _______

Answer 8

firm and rubbery

Question 9

Patho: How does lung trauma lead to impaired GE?

Answer 9

lung trauma–> inflm cell reflux–> release of free radicals and proteases–> damage to alveoli and capillaries–> increase perm–> proteins, cells, and fluid enter IS and alveoli—> edema –> l/o compliance –> impaired GE

Question 10

Exudate accumulating in alveolus and IS leads to pulm ____ —> increase ______ ____ —> impact GE

Answer 10

edema

diffusion distance

Question 11

Person may end up in ____-____ failure

Answer 11

multi-organ

Question 12

PAtho: What is diffusion consolidation? What appearance does it give?

Answer 12

solidification of fluid, debris, and cells –> become non-functional

if diffuse enough most of lungs do not work

rubbery

Question 13

Patho: How does l/o surfactant lead to atelectasis

Answer 13

w/ increase permeability–> protein enter the alveolus–> protein interact with surfactant and change the properties of surfactant—> surfactant become inactive or inadequate–> atelectasis

Question 14

What is surfactant? What secrete surfactant? Fxn?

Answer 14

A mixture of lipids and proteins secreted by type II alveolar cells

Surfactant decrease surface tension between alveolar cells

Question 15

Patho: What is the impervious hyaline membrane? Is it cartilage and a membrane? Why is it called a membrane?

Answer 15

Protein rich thick exudate and cellular debris forms a band that lines the alveoli

Not an anatomical membrane or cartilage

It is called a membrane b/c it forms a band

Question 16

What is the appearance of the hyaline membrane?

Answer 16

glossy and hard

Question 17

What does impervious mean? What does it result in?

Answer 17

nothing can move across –> no GE –> hypoxia

Question 18

In hyaline membrane, if gases can move across, the ____ ______ is too large for GE

Answer 18

diffusion distance

Question 19

Damaged cell release free radicals and proteases. How does it contribute to damage?

Answer 19

1. oxidative damage

2. break down structure protein of alveoli and capillaries

Question 20

Patho: what does profound hypoxia lead to?

Answer 20

vital organ suffers and leads to death

Question 21

What occurs when injurious agent enter the lungs? (2)

Answer 21

vasodialtion and hyperemia

Question 22

Manifestations of ARDS (8)

Answer 22

1. severe acute respiratory distress
2. tachypnea (comp mech to hypoxia)
3. dyspnea (associated wirh hypoxia)
4. increase hypoxemia (profound hypoxia)
5. pulm HTN (hypoxia in lungs lead to comp vasoconstriction)
6. early respiratory alkalosis
7. late metb acidosis
8. multi-organ failure

Question 23

Explain early respiratory alkalosis. What is carbonic acid?

Answer 23

tachypnea–> exhaling lots of CO2–> CO2 is removed –> less carbonic acid is made–> increase pH–> early respiratory alkalosis

Volatile acid

Question 24

Explain late metb acidosis

Answer 24

tachypnea–> increase workload of breathing–> the person utilizing more muscles for breathing (both accessory and normal muscles)–> increase ATP demand for energy which req more O2 –> not enough O2 for the energy demand–> cells move into glycolysis for energy –> lactic acid is a by-product –> metb acidosis

Question 25

What do fixed acid indicate?

Answer 25

metb acidosis eg lactic acid

Question 26

complications of ARDS (4)

Answer 26

1. pulm HTN
2. early resp alkalosis
3. late metb acidosis
4. multi-organ failure

Question 27

Treatment of ARDS

Answer 27

1. stat detection and intervention–> good prognosis
2. respiratory support —>eg indirectly supporting organ, O2 supplement, and mech ventilation
3. address underlying cause eg remove from fire or save from drowning
4. eliminate complications