Case study: acute respiratory distress syndrome (a
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Case Study: Acute Respiratory Distress Syndrome
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Case Study: Acute Respiratory Distress
Syndrome (ARDS) NUR 401
Scenario: Rocky is a 56 y.o. aeronautical scientist who was involved in
a motor vehicle crash (MVC). He was the driver of a vehicle that was hit
head-on, pinning him behind the steering wheel. The airbag deployed.
He was intubated on scene by pre-hospital personnel and air lifted to a
Level I Trauma Center. In the emergency department (ED) the trauma
examination and work up revealed bilateral flail chest, right hemo-
pneumothorax, splenic laceration, liver laceration, open fracture to the
right tibula-fibula and probable cardiac contusion. He was quickly
transferred from the ED to the operating theatre (OR) for repair of his
injuries. In the OR he received 36 units of packed red blood cells
(PRBCs) 20 units of platelets, 12 units of fresh frozen plasma (FFP), and
18 liters of lactated Ringer’s solution. Post-operatively he was taken to
the Surgical-Trauma ICU for recovery and continued care. In the ICU,
Rocky’s pulmonary status continued to require higher levels of
mechanical support and higher levels of oxygen (FiO2). His daily chest
radiograph (CXR), continued to worsen with the latest read being
bilateral lung opacities, consistent with acute respiratory distress
syndrome (ARDS).
1. What is ARDS?
Is a systemic process that is considered to be the pulmonary
manifestation of Mods. It is characterized by noncardiac
pulmonary edema and disruption of the alveolar capillary
membrane as a result of injury to either the pulmonary
vasculature or the airways
2. What are the risk factors for developing ARDS? Which does Rocky
have?
This study source was downloaded by 100000841990434 from CourseHero.com on 04-30-2022 11:48:54 GMT -05:00
, Direct: aspiration, near drowning, toxic inhalation,
pulmonary contusion, pneumonia, oxygen toxicity, and
transthoracic radiation
Indirect: sepsis, non-throacic trauma, hyper-transfusion,
cardiopulmonary bypass, severe pancreatitis, embolism (air,
fat, amniotic fluid, DIC, and shock states
Rocky has hemo-pneumothorax, potential DIC due to liver
laceration, shock state : hypovolemic due to severe blood
loss (many units of platelets, PRBCs, FFP, LR), Non thoracic
trauma ( cardiac contusion and splenic laceration); Hyper
transfusion can cause injury to alveoli which can lead to
ARDS.
Case Progression
Rocky’s ventilator settings have increased to assist and support his
worsening pulmonary status. Currently, his ventilator settings are: Assist
Control (AC) with rate of 14, FiO2 90%, Vt 450 mL, Pressure support
(PS) 22; positive end expiratory pressure (PEEP) 12. He is sedated on
propofol to a RASS score of -4 (minus 4).
3. What is the RASS score? What is the significance of titrating the
propofol to a RASS of 4) while on the current ventilator settings?
A Rass score is a sedation scale and it can also detect delirium
in ICU patient; a score of 4 is a deep sedation, no response to
voice, but movement or eye opening to physical stimulation.
This allows the body to stabilize while in major distress states
and it allows for that patient to reduce the work of breathing
and allow for ventilatory muscle rest and recover.
4. Explain the current ventilator mode of AC.
Assist control delivers a fixed volume regardless of
This study source was downloaded by 100000841990434 from CourseHero.com on 04-30-2022 11:48:54 GMT -05:00
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