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S2 E060 Pulmonology – ARDS and more for the PANCE

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<< Click here to get 40 Pulmonology questions straight from my book The Final Step >>

Other Pulmonary Disease

Acute Respiratory Distress Syndrome (ARDS)

  • Severe inflammation of the lung tissue which impairs gas exchange secondary to acute injury secondary to pulmonary edema
  • Without treatment 90% of patients will die

Things associated with the onset of ARDS

  • The majority of ARDS cases are seen in these settings
    • Sepsis
    • Severe trauma
    • Aspiration of gastric contents
  • Other possible settings for ARDS
    • Near drowning
    • Inhalation of toxins
    • Shock
    • Burns
    • Pancreatitis
    • Disseminated intravascular coagulation (DIC)
    • Thrombotic thrombocytopenia (TTP)
    • Pneumonia
    • Miliary TB
    • Lung contusion
    • High altitude exposure

Clinical Presentation

  • Onset within 12 – 24 hours
  • Acute onset dyspnea
  • Acute onset tachypnea
  • Frothy red sputum

Labs, studies and physical exam findings

  • Diffuse crackles
  • Hypoxemia that does not respond to oxygen
  • Chest x-ray
    • May be normal
    • Bilateral opacities with no other explanation

Treatment

  • Intubation and mechanical ventilation
  • Treat underlying causes

Hyaline Membrane Disease/Respiratory Distress Syndrome

  • Occurs in premature infants due to insufficient production of surfactant

Clinical Presentation

  • Tachypnea
  • Tachycardia
  • Retractions
  • Nasal flaring
  • Apnea

Labs, Studies and Physical Exam Findings

  • Chest x-ray
    • Decreased lung volume
    • Diffuse atelectasis giving a ground glass appearance

Treatment

  • Prevention
    • Steroids are given if there is a risk of delivery before 34 weeks gestation
  • Oxygen
  • Positive airway pressure
  • Intubation
  • Surfactant spray

Foreign Body Aspiration

  • More frequent in children and elderly

Clinical Presentation

  • Wheezing
  • Drooling
  • Dyspnea
  • Foul smell

Labs, Studies and Physical Exam Findings

  • Chest x-ray showing air trapping

Treatment

  • Removal of foreign body under anesthesia if necessary
  • Heimlich

Study Tip – Set the stage

<< Click here to get 40 Pulmonology questions straight from my book The Final Step >>