ARDS, ARF

Proning in Patient Care

  • Proning:
    • Typically performed for 2 to 3 hours at a time.
    • Post-COVID protocol suggests prolonged periods, possibly 6 to 8 hours once a day.
    • Purpose of proning:
    • Increases capillary perfusion.
    • Redistributes blood flow.
    • Changes the diaphragm position.
    • Facilitates secretion removal:
      • As secretions shift, it helps ease removal and promotes alveoli opening.

Acute Respiratory Distress Syndrome (ARDS)

  • Definition: ARDS falls under the category of acute respiratory failure (ARF).
  • Characteristics of ARDS:
    • Patients are unable to oxygenate and ventilate adequately.
    • If untreated, ARDS can progress to:
    • Pulmonary hypertension.
    • Right-sided heart failure.
    • Eventually leading to pulmonary fibrosis.
    • Patients remain hypoxic despite being given 100% oxygen.
  • Diagnosis Indicators:
    • Non-cardiogenic pulmonary edema.
    • Ground glass opacities visible on chest X-rays.
    • ARF is seen as a symptom, not an independent disease.

Determining Acute Respiratory Failure

  • Indicators include:
    • pH < 7.35
    • PaO2<60P_aO_2 < 60
    • PaCO2>50P_aCO_2 > 50

Neuromuscular Blocking Agents

  • Do they relieve pain? No.
  • Do they paralyze the patient? Yes, but not in terms of ventilation; they prevent voluntary movement, leading to respiratory arrest.
  • Example: Succinylcholine – a neuromuscular blocker that induces paralysis but does not provide analgesia or sedation.

Rapid Sequence Intubation

  • Step 1: Sedation
    • Common agents: Midazolam, Ativan, Versed.
  • Step 2: Anesthetic
    • Common agents: Propofol, Etomidate.
    • Important note: In New York State, nurses cannot administer Propofol via IV push; it must be given as a drip.
  • Step 3: Neuromuscular Blocking Agents
    • Examples: Succinylcholine, Rocuronium, Vecuronium.
    • Administer in the order: Sedative → Anesthetic → Paralytic.
    • Incorrect order (e.g., giving paralytics first without sedation) can lead to severe patient distress and complications.

Causes of Physiological Anxiety in Patients

  • Key Cause: Hypoxia
    • Example symptoms include sudden drops in oxygen saturation:
    • Example: A patient’s stats fall from 99% to 90%.
    • Investigate any sudden changes in saturation levels for non-respiratory patients.

Malignant Hyperthermia

  • Definition: A potentially fatal reaction associated with certain anesthetics, which may have hereditary links.
  • Signs and Symptoms:
    • Increased body temperature.
    • Muscle rigidity.
    • Tachycardia.
    • Muscle spasms.
  • Life-Threatening Nature: Requires rapid treatment.
    • Treatment involves administering Dantrolene promptly.
    • Ensure availability of malignant hyperthermia cart in OR settings.
  • Post-operative protocol:
    • Regularly monitor patient temperatures after surgery or administration of succinylcholine.
    • Report any spikes in temperature, muscle rigidity, or spasms immediately and call for rapid response.

Pulmonary Embolus vs. ARDS

  • Pulmonary Embolus:
    • Obstructs blood flow to pulmonary system.
    • Results in crackles due to lack of blood flow.
  • Understanding Differences:
    • Recognizing clinical features is critical for differential diagnosis between ARDS and pulmonary embolism.

Conclusion

  • Knowledge of protocols regarding sedation, anesthetics, paralytics, and monitoring for side effects such as malignant hyperthermia is essential for effective patient management in emergency and surgical settings.