Test 4 - Ch. 28 ARDS

Question 1

In gross appearance the lungs of patients with ARDS are _________________.

Answer 1

Heavy and “red”, “beefy” or “liverlike”

Question 2

What are the major pathologic or structural changes associated with ARDS?

Answer 2

• Interstitial and intraavleolar edema and hemorrhage
• Alveolar consolidation
• Intraalveolar hyaline membrane formation
• Pulmonary surfactant deficiency or qualitative abnormality
• Atelectasis

Question 3

As the ARDS disease progresses, the intraalveolar walls become lines with thick, rippled ____________.

Answer 3

Hyaline membrane

Question 4

Historically, ARDS was first referred to as what?

Answer 4

The “shock lung syndrome” when the disease was first identified in the combat casualties during WWII.

Question 5

ARDS accounts for ______% of all ICU admissions and ______ of patients on mechanical ventilation.

Answer 5

ARDS accounts for 10-15% of all ICU admissions and about 25% of patients on mechanical ventilation.

Question 6

What are the most common causes of ARDS?

Answer 6

• Sepsis
• Aspiration
• Pneumonia
• Severe trauma
• Drug abuse
• Massive blood transfusion
• Massive traumatic tissue injury
• Fat embolism from a long-bone fracture
• Bilateral lung contusion

Question 7

The clinical manifestations associated with ARDS usually appear within ________ of an inciting event and worsen rapidly.

Answer 7

6-72 hours

Question 8

Berlin Definition of Mild ARDS

Answer 8

PaO2/FiO2 >200, but less than or equal to 300

Question 9

Berlin Definition of Moderate ARDS

Answer 9

PaO2/FiO2 >100, but less than or equal to 200

Question 10

Berlin Definition of Severe ARDS

Answer 10

PaO2/FiO2 less than or equal to 100

Question 11

ARDS: Physical Examination

Answer 11

• Increased RR
• Increased HR and BP
• Substernal and intercostal retractions
• Cyanosis
• Dull percussion note
• Bronchial breath sounds
• Crackles

Question 12

ARDS: Radiologic Findings

Answer 12

• Increased opacities, diffusely throughout the lungs

Question 13

Which disease process would show a “ground-glass” and “honey comb” appearance on a CXR?

Answer 13

ARDS

Question 14

What are some common complications of ARDS?

Answer 14

• Barotrauma
• Volutrauma
• Delirium
• DVT
• GI bleeding attributable to stress ulceration
• Pneumonia

Question 15

What type of pneumonia is commonly associated with ARDS?

Answer 15

• Streptococcus pneumoniae

Question 16

__________________ significantly reduce the rate of treatment failure both early and late based on radiographic progression and late septic shock.

Answer 16

IV corticosteroids

Question 17

If the Pplat drops below 25 cm H2O, what is the most common protocol?

Answer 17

Increase tidal volume

Question 18

For ARDS patients, their RR should not exceed ____ breaths/min

Answer 18

35

Question 19

Normal PaO2/FiO2

Answer 19

Above 400

Question 20

What is the protocol for ARDS?

Answer 20

• Low tidal volume
• High RR
• High PEEP

Question 21

What is the most common cause of ARDS?

Answer 21

Sepsis