Adult Acute Respiratory Distress Syndrome - PowerPoint PPT Presentation

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Adult Acute Respiratory Distress Syndrome

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Adult (Acute Respiratory Distress Syndrome. Paramedic ... Viral pneumonia. Smoke inhalation. Cardogenic pulmonary edema. Complications. Respiratory failure ... – PowerPoint PPT presentation

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Title: Adult Acute Respiratory Distress Syndrome


1
Adult (Acute Respiratory Distress Syndrome
  • Paramedic Program
  • Chemeketa Community College

2
What in the heck is ARDS?
  • A fulminent form of respiratory failure
  • Noncardiac pulmonary edema
  • Acute lung inflammation
  • Diffuse alveolar-capillary injury
  • 200,000 cases per year
  • Mortality 40-70
  • Severe hypoxia

3
  • Intrapulmonary shunting
  • Reduced lung compliance
  • Irreversible parenchymal lung damage
  • Usually healthy lungs before event
  • More common in men

4
A complication of injury or illness
  • Trauma
  • Direct pulmonary injury
  • Multiple trauma
  • Gram-negative sepsis
  • Gastric aspiration
  • Cardiopulmonary bypass surgery

5
Complications, cont.
  • Multiple blood transfusions
  • Oxygen toxicity
  • Toxic inhalation
  • Pneumonia
  • OD (tricyclics, heroin, methadone, barbiturates,
    salicylates)
  • Infections
  • Drowning (12-24 hours)

6
Yes, but what happens?
  • Increased capillary permeability wet congested
    lungs decreased perfusion capacity
  • Decreased pulmonary compliance
  • Requires higher airway pressure

7
3 phases
  • Exudative phase injury to endothelium and
    epithelium, inflammation, fluid exudation
  • Fibroproliferative phase influx and
    proliferation of fibroblasts injury may begin to
    resolve or become persistant
  • Fibrosis phase resolution of inflammation
    development of pulmonary fibrosis

8
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9
Diffuse Alveolar Damage
10
The patient
  • Onset w/in 72 hours
  • Mild tachypnea may be only manifestation
  • Labored breathing, tachypnea
  • Cyanosis
  • Moist skin
  • Hyperventilation
  • Scattered crackles/rales

11
  • Absent signs of volume overload
  • 3rd heart sound
  • JVD
  • Agitation
  • Lethargy
  • Obtundation

12
DDX
  • CHF
  • Pulmonary edema
  • Aspiration pneumonia
  • Bacterial pneumonia
  • Immunocompromised pneumonia
  • Viral pneumonia
  • Smoke inhalation
  • Cardogenic pulmonary edema

13
Complications
  • Respiratory failure
  • Cardiac dysrhythmias
  • Disseminated intravascular coagulation
  • Barotrauma
  • Congestive heart failure
  • Renal failure
  • Multiple organ failure

14
Management
  • Always high oxygen
  • Sa02
  • IV
  • ET prn
  • PEEP or CPAP
  • Maintain Sa02 at 92-94
  • Fluid replacement to maintain cardiac output

15
Management, cont.
  • Corticosteroids - controversial
  • Diuretics
  • Consider Dobutamine
  • 2.5 mcg/kg/min titrate to effect

16
Work up in the ED
  • ABGs
  • CXR
  • Sputum collection

17
Important to recognize
  • Patients who have been resuscitated may have a
    period of relative stability followed by
    deterioration
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