(Adult) Acute Respiratory

Distress Syndrome
Paramedic Program
Chemeketa Community
College
What in the heck is ARDS?
 A fulminent form of respiratory failure
 Noncardiac pulmonary edema
 Acute lung inflammation
 Diffuse alveolar-capillary injury
 ~ 200,000 cases per year
 Mortality 40-70%
 Severe hypoxia
 Intrapulmonary shunting
 Reduced lung compliance
 Irreversible parenchymal lung damage
 Usually healthy lungs before event
 More common in men
A complication of injury or illness

 Trauma Gram-negative sepsis

 Direct
Gastric aspiration
pulmonary
injury Cardiopulmonary
 Multiple bypass surgery
trauma
Complications, cont.
 Multiple blood  OD (tricyclics,
transfusions heroin, methadone,
 Oxygen toxicity barbiturates,
 Toxic inhalation salicylates)
 Pneumonia
 Infections
 Drowning (12-24
hours)
Yes, but what happens?
 Increased capillary permeability = wet
congested lungs; decreased perfusion
capacity
 Decreased pulmonary compliance
 Requires higher airway pressure
3 phases
 Exudative phase – injury to endothelium
and epithelium, inflammation, fluid
exudation
 Fibroproliferative phase – influx and
proliferation of fibroblasts; injury may begin
to resolve or become persistant
 Fibrosis phase – resolution of inflammation;
development of pulmonary fibrosis
 pH=7.45
pCO2=34
pO2=182
Saturation 99.5

pH=7.47
pCO2=31
pO2=59
Saturation 91
The patient
 Onset w/in 72 hours
 Mild tachypnea may be only manifestation
 Labored breathing, tachypnea
 Cyanosis
 Moist skin
 Hyperventilation
 Scattered crackles/rales
 Absent signs of volume overload – 3rd
heart sound, JVD, Agitation
 Lethargy
 Obtundation
DDX
 CHF
 Pulmonary edema
 Aspiration pneumonia
 Bacterial pneumonia
 Immunocompromised pneumonia
 Viral pneumonia
 Smoke inhalation
 Cardogenic pulmonary edema
Complications
 Respiratory failure
 Cardiac dysrhythmias
 Disseminated Intravascular Coagulation
 Barotrauma
 Congestive Heart Failure
 Renal failure
 Multiple organ failure
Management
 Always – high oxygen
 Sa02
 IV
 ET prn
 PEEP or CPAP
 Maintain Sa02 at 92-94%
 Fluid replacement to maintain cardiac output
 Corticosteroids - controversial
 Diuretics
Management, cont.
 Consider Dobutamine
 2.5 mcg/kg/min; titrate to effect
Work up in the ED
 ABG’s
 CXR
 Sputum collection
Important to recognize
 Patients who have been resuscitated may
have a period of relative stability followed
by deterioration