ARDS

 

Etiology:

  1. Sepsis, Drugs (e.g. OD on heroin), Aspiration, Inhalation, Trauma/Burn, High altitude, DIC, Head trauma.
     
  2. Common denominator to ARDS is involvement of Compliment, Coagulation and Arachidonic acid cascades that result in Surfactant inactivation.

S & S:

  1. Tachypnea, Dyspnea, Tachycardia.

DX:

  1. Rales on auscultation
     
  2. ABG,
     
  3. CXray,
     
  4. PAWP is normal on Swan-Ganz (as compared to CHF),
     
  5. Aspirated fluid analysis. When osmotic pressure of fluid and plasma ratio are >60 this favors ARDS.

Treatment:

  1. Identify and treat the underlying cause.
     
  2. Intubate.
     
  3. If  high FiO2 is required to keep adequate oxygenation, since high FiO2 is  harmful it is advised to put the pt on PEEP (unless contraindicated  as in head trauma). The latter, when  too  high may:
     
    1. aggravate already diminished  venous return and thus further   in O2 supply,
    2. cause hypotension,
    3. cause barotrauma.

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