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ARDS - Trauma Patients and Acute Respiratory Distress...

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Trauma Patients and Acute Respiratory Distress Syndrome Lynn Kemp, R.N. Trauma Coordinator St. Barnabas Hospital
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Definition A syndrome of acute respiratory failure characterized by non-cardiac pulmonary edema and manifested by refractory hypoxemia caused by intrapulmonary shunt and diffusion barrier
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Direct Injury Chest trauma – pulmonary contusion Near-drowning Hypervolemia – pulmonary edema Inhalation of toxic gases and vapors Pulmonary embolism Pneumonia (viral, bacterial or fungal)
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Indirect Injury Sepsis Shock or prolonged hypotension Multi-system trauma, especially multiple fractures Burns DIC Acute pancreatitis Head Injury Abdominal trauma Multiple blood transfusions
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Pathophysiology Onset of symptoms is usually 12 – 48 hours after time from acute injury Has acute and chronic phases
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Acute phase Acute lung injury Reduces normal perfusion to the lungs Causes platelet aggregation and stimulation of the inflammatory-immune system
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Acute phase Release of mediators of the inflammatory process Mediators activate neutrophils, macrophages and other cells to release toxic substances that cause microvascular injury
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Acute phase Acute and diffuse injury to endothelium and epithelium surface of lung occur Damage to pulmonary capillary membrane and increase in capillary permeability occurs
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Acute phase Capillary leak allows proteins and fluids to spill into the interstitium and alveolar spaces Pulmonary lymphatic drainage capacity is overwhelmed and alveolar flooding occurs
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