At early stage, pt may be asymptomatic, or only mildy tachypnic
Crackles at the bases on auscultation.
No signs of volume overload (S3, JVP)
Respiratory alkalosis may be present at early stage.
Hypercarbia and respiratory acidosis at later stage.
Baseline tests and for sepsis
For sepsis
For liver/coagulation problems
Bilateral diffuse infiltrate
Absence of vascular redistribution
May be normal at early stage, but may rapidly progress to complete white-out of both lung fields.
Cardiac monitor
Pulse-oximeter
Time-cycled BP cuff
IV access
[Fluid if hypotensive.]
[Volume overload may significantly worsen pulmonary oedema]
100% Oxygen
[Keep SpO2>90%]
If SpO2<90% on O2, or fatigue or hypercarbia
---> Endotracheal intubation
If mechanical ventilation cannot keep SpO2>90%
---> Increase PEEP slowly
[Higher airway pressure may decrease venous return and lead to hypotension]
PEEP (positive end-expiratory pressure) is very important as it helps minimising alveolar
Routine or prophylatic use of antibiotics or corticosteriods ---> no proven benefit.
CXR changes, hypoxia, respiratory alkalosis ---> ICU admission.
Mortality - 40 to 60%
Sepsis
Severe tramatic injury
Multiple transfusion
[Risk increases with the number of units used, and presence of liver disease or coagulation abnormality]
Near-drowning
[More common after salt water aspiration than fresh water.]
[Develops in 12-24 hours.]
[Better prognosis if develops after 6 hours]
Smoke inhalation
[via direct thermal damage, and chemical irritation]
Drugs
ARDS - pulmonary oedema in the absence of volume overload or depressed left ventricular function.
Injury results in loss of the integrity of the alveolar-capillary membrane and increased permeability to plasma
---> Fluid enters alveolar space, disrupting the function of pulmonary surfactant
---> Microatelectasis
---> V/Q mismatch and shunting of blood
Congestive Heart Failure and Pulmonary Oedema
Pneumonia
Irritant gas inhalation
Things to revise/add later:
Bibliography: "eMedicine On The Go"
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Created | 20040212 |
Updated | 20040212 |