Acute Respiratory Distress Syndrome

Acute Respiratory Distress Syndrome

• Pick one critical illness that you will likely see in the acute care setting.
• Provide a brief overview of the pathophysiology of this condition.
• Discuss common signs and symptoms and consider unique presentation of this condition.
• Discuss how this condition is ultimately diagnosed.
• Discuss how the patient will be managed in the emergency department (Consider initial lab tests, medications, imaging, etc).
• Discuss criteria for considering admission to the intensive care unit.
• Discuss management strategies for intensive monitoring of this condition.
• Discuss discharge planning for this scenario and consider when the patient is stable enough to step down from the critical care unit and then discharged home, to a skilled nursing facility, rehabilitation or other outpatient center.
• Should include a minimum of three peer-reviewed references from scholarly articles no more than 5 years old. This does not include your textbook or websites.
• Should also include one national guideline.

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Answer

Critical Illness Overview: Acute Respiratory Distress Syndrome (ARDS)

Pathophysiology

Acute Respiratory Distress Syndrome (ARDS) is a severe inflammatory condition of the lungs characterized by increased pulmonary permeability, resulting in the accumulation of protein-rich fluid in the alveolar space, impaired gas exchange, and reduced lung compliance. ARDS can arise from various precipitating factors, including pneumonia, sepsis, aspiration, trauma, and inhalation injury. The condition typically progresses through three phases:

1. Exudative Phase (0-7 days): Inflammatory mediators are released in response to injury, causing endothelial damage and increased vascular permeability. This leads to edema formation in the alveoli, hindering gas exchange.
2. Proliferative Phase (7-14 days): Repair mechanisms are activated, leading to the proliferation of type II alveolar cells and fibroblasts, with the formation of hyaline membranes and fibrosis.
3. Fibrotic Phase (>14 days): Persistent inflammation and fibrotic changes can occur, leading to reduced lung function and potential long-term complications.

Common Signs and Symptoms

Patients with ARDS typically present with acute onset of dyspnea, tachypnea, hypoxemia, and bilateral infiltrates on chest imaging. Additional signs may include:

• Cyanosis: Due to impaired oxygenation.
• Altered mental status: Resulting from hypoxemia.
• Respiratory failure: May require supplemental oxygen or mechanical ventilation.

Unique Presentations: In some cases, patients may initially present with subtle respiratory symptoms or may be in a state of…