Acute Respiratory Distress Syndrome - CRASH! Medical Review Series

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(Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)

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Very good lecture. I am a radiologist. It is very hard to judge the CT ratio on a portable supine CXR, especially with suboptimal lung volumes.. Please keep that in mind. If the values of PaO2?FiO2 are given with the request for CXR, the radiologist can give a more meaningful interpretation.

rameshpatel

Thursday, October 6, 2022. Pulmonology: Acute Respiratory Distress Syndrome (ARDS) is a Rapid and Sudden widespread Pulmonary Edema Status Post Systemic And/or Pulmonary Insult/Disease and is characterized further by a Reduced Oxygen Diffusion Across Alveolar/Capillary Membrane (Multiple Organ Dysfunction Syndrome [MODS] is a possibly Concomitant to ARDS; DDx: 1) Cardiogenic Pulmonary Edema, 2) Primary Pulmonary Hypertension, a most manageable Primary Disease of the Lung (Idiopathic Cause); Aetiology of ARDS: 1) Sepsis (Most Common Cause), 2) Chemical/Gas Exposure, 3) Trauma, 4) Burns, 5) Gastric Aspiration, 6) Near-Drowning, 7) Acute Pancreatitis, 8) Transfusion, or 9) Other Causes; Hx: Known or Unknown Trigger (Infection), Pulmonic Trauma or Non-Pulmonic Trauma; SSx: 1) Labored Breathing, 2) Intercostal Retraction, 3) Tachypnea, 4) Crackles and Rales on Auscultation, and Anxiety/Agitation; Px: 1) Uniformly Low Saturation Level (Those Below 90%) notwithstanding Oxygen Therapy; 2) when Septic there is Pyrrhexia/Fever and Hypothermia; 3) Cyanosis maybe a Feature; Mx: 1) Stabilization of the Subject, 2) Mechanical Ventilation (Positive End-Expiratory Pressure [PEEP]) is often Necessary for Saturation Deficiency (< 90%); In Regards to Diagnosis (Dx): 1) Chest X Ray (CXR) is Essential (Bilateral Infiltrates Present and Cardiac Silhouette will be Normal); 2) Arterial Blood Gases (ABGs) for Partial Pressure of Arterial Oxygen (Pa02) Status (Low Pa02 and PaC02 will be Normal to High) 3) B-Type Natriuretic Peptide (BNP) Levels will assist in Accordingly Characterizing the Ongoing Aetiologic Pathology: 1) ARDS (BNP is Normal) or 2) Cardiogenic Pulmonary Edema (BNP is Elevated); Also, the Pulmonary Capillary Wedge Pressure (PCWP) will be Normal (< 18 mmHg; Exclusion of Cardiogenic Pulmonary Edema Thereby); When PaO2/FiO2 Ratio is Less than 200 ARDS is Identified; Tx: 1) Identifying and Treating Underlying Aetiology (Sepsis is 33% of the Cases); 2) Mechanical Ventilation (PEEP) with the Titration of Fi02 to Maintain/Achieve 90% Saturation; 3) Serial or Frequent CXRs and ABGs for Monitoring Resolution; 4) Therapeutic Goal is to Wean of Mechanical Ventilation by reducing Fi02 within 2 Days to 60% (Avoiding Oxygen Toxicity); 5) ARDS entails a Patent Foramen Ovale (PFO) Screening via 2D Echocardiogram; 6) Fluid Management is a Conservative Range (Edema is Already Problematic) guided by "err on the Low-Normal Side"; Blood Pressure Guide is over 100/70; 7) Resolution Monitoring also is via Pa02/Fi02 Ratio (Defining Feature of ARDS); 8) ICU Bed-Rest Protocols (Prone Positioning and Acid Reduction Therapy); 9) Glucocorticoid Steroids are Controversial and are Contraindicated for a Lack of Scientific-Based Evidence in Effectivity (No Study shows Effectivity); In Nasal Canula (NC) Oxygen Supplementation, the Formula Liter/MInutes NC x (The Number of Liters x 4 )= NC Fi02; In Regards to the Definition of ARDS in term of Pa02/FiO2, 1) Mild ARDS is Pa02/Fi02 = 200 to 300; 2) Moderate ARDS is Pa02/Fi02 = 100 to 200; and 3) Severe ARDS is Pa02/Fi02 Ratio = < 100; Goodness, I have seen ARDS come to its full Fruition with SARS-CoV-2/COVID-19's so-called Pandemia (Controversial Topic). My preference was to have Severe ARDS be treated with some Cytotoxic Agent or the Antimalarial/DMARDs like Hydroxychloroquine (HCQ). Just Kidding. Monoclonal Antibodies (Mabs) are just fine Herein. MD Paul Bolin, es gut zu lernen und lehrer ist aber zu fuehren man muss haben immer die Hegemonie. Heil!

woloabel

Thank you so much for all your lectures. My school recommends your lectures.

patricianmukosoenyi

First of all thank you so much for your efforts. I think there is a little mistake at the end of the examle. The calculations must be done with the pao2 ratio but it gives o2 saturation rates at the beginning of the sentence. Again small warning just for the viewers.

profgaliba

For the second picture “CXR” @ 13:00 you can never comment on the heart enlargement with “portable x-ray”.
That’s why it appears a little bit enlarged

rakoos