ARDS
What is the criteria for ARDS?
Refractory Hypoxemia
Decreased pulmonary compliance
Dyspnea
Dense pulmonary infiltrates on x-ray (ground glass appearance)
With DKA, the onset is _____
sudden/rapid
Restlessness, irritability, agitation, fatigue, confusion, tachycardia, tachypnea, and cyanosis (late sign) are all symptoms of ______
hypoxemic respiratory failure
With HHS, the onset is _____
gradual/slow
What characterizes severe COVID-19?
Hypoxemia
Need for 02 or vent support
List some common causes of an AKI
Shock, trauma, burns, pancreatitis, aspiration, pneumonia, drugs, sepsis, blood transfusions, drowning
What is the most common cause of DKA and HHS?
Infection
Combined oxygenation and ventilatory failure involves ________, which may lead to atelectasis
hypoventilation
With fluid replacement in HHS, you are running your fluids at ____ when you start
1L an hour
What is one of the first interventions for patients with COVID-19 and ARDS?
Prone Positioning
What is the MOST common cause of an AKI leading to ARDS?
Sepsis :)
In DKA, the _______ will kill you faster, so the first intervention is _______
Metabolic Acidosis ; Insulin
What are the two types of Acute Respiratory Failure?
type 2 - hypercapnia/ventilatory failure
or a combo of both
In HHS, the _____ will kill you faster, so the first intervention is ______ _____
Dehydration; Fluid Replacement
What are some medications used in the treatment of COVID-19?
Glucocorticoids (dexamethasone)
Remdesivir
Tocilizumab
JAK inhibitor
Monoclonal antibodies (limited)
What does TRALI stand for?
Transfusion-related Acute Lung Injury.
What are the 3 p's?
polydipsia, polyphagia, polyuria
What are some common causes of oxygenation failure?
obstruction (infection, angioedema, aspiration)
pneumonia
atelectasis
COVID
shock
hypoventilation
high altitudes, smoke inhalation, carbon monoxide poisoning
The expected outcomes of therapy are to _____ the patient and restore normal glucose levels within ____ to ____ hours
Rehydrate ; 36 to 72 hours
What labs will be abnormal with severe/critical COVID-19?
D-Dimer (over 1000) (higher risk of blood clots/PE)
CRP (over 75)
LDH (over 245)
Troponin (elevated over 2)
Ferritin (over 500)
Describe the patho of ARDS
Triggered by an alveolar injury leading to systemic inflammatory response (known as a cytokine storm). The injury causes damage and scarring to the alveolar membranes, making them more suseptable to infection/damage/etc
What electrolyte will be high due to the metabolic acidosis?
Potassium
What are some medications that may be given for Acute Respiratory Failure?
Corticosteroids
Analgesics
Neuro blocks or sedation (if vented)
02 therapy
Half of the estimated fluid deficit is replaced within the first _____ and the rest is given over the next ____
12 hours ; 36 hours
What are interventions to prevent Ventilatory Associated Pneumonia (VAP)
HOB elevated 30 degrees
Oral care per policy
Ulcer prophylaxis
Preventing aspiration
Subglottic suctioning
Pulmonary hygiene (turning and positioning)
Minimizing sedation
daily assessment for extubation
Maintain ET tube cuff pressure 20-30cm (or 15 to 22 mmHg)