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<p><span style="font-family: 'times' , 'times new roman' , serif">Acute respiratory distress syndrome commonly known as ARDS is a life-threatening medical condition whereby the lungs cannot provide sufficient oxygen for the body.</span><br />
<b><span style="font-family: 'times' , 'times new roman' , serif">Causes</span></b><br />
<span style="font-family: 'times' , 'times new roman' , serif"><span style="font-family: 'times' , 'times new roman' , serif"><span style="font-weight: normal">This condition develops when the lungs has become infected or sustained an injury leading to inflammation. The inflammation causes fluid from nearby blood vessels to leak into the tiny air sacs in the lungs, making breathing increasingly difficult.</span></span></span></p>
<p>Inflammation can be caused by:</p>
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<li><span style="font-family: 'times' , 'times new roman' , serif">Sepsis</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Pneumonia</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Severe chest injury </span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Accidental inhalation of vomit, smoke or toxic chemicals</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Acute pancreatitis</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Blood transfusion reaction</span></li>
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<div style="font-family: ''; margin-bottom: 0.0001pt"><b><span style="font-family: 'times' , 'times new roman' , serif">Clinical Features</span></b><br />
<span style="font-family: 'times' , 'times new roman' , serif">Theses can occur within 24 to 48hrs of illness and can include:</span></div>
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<li><span style="font-family: 'times' , 'times new roman' , serif">Severe shortness of breath</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Rapid, shallow breathing</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Low blood pressure</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Tiredness, drowsiness or confusion</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Feeling faint</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif; line-height: 16.532169342041016px">Organ failure</span></li>
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<div style="font-family: ''"><span style="font-family: 'times' , 'times new roman' , serif"><span style="font-family: 'times' , 'times new roman' , serif; font-weight: normal">Normally, these patients are so sick that they cannot complain of symptoms.</span></span></div>
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<p><b><span style="font-family: 'times' , 'times new roman' , serif"><span style="font-family: 'times' , 'times new roman' , serif">Diagnosis</span></span></b></p><div class="fRSfyG0L" style="clear:both;float:left;width:100%;margin:0 0 20px 0;"><script async src="https://pagead2.googlesyndication.com/pagead/js/adsbygoogle.js?client=ca-pub-9851445956456483" 
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<div style="margin: 0px"><span style="font-family: 'times' , 'times new roman' , serif">A full assessment is carried out and include the following:</span></div>
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<li><span style="font-family: 'times' , 'times new roman' , serif">Physical examination</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Blood test to ascertain oxygen saturation and check for signs of infection</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Arterial blood gases(ABG) for continous monitoring of respiratory state, blood volume and electrolytes.</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Blood and urine culture</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Pulse oximetry test for continuous monitoring of oxygen saturation</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Chest X-ray and a computerised tomography (CT) scan – to look for evidence of ARDS</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Echocardiogram to picture the heart ; to rule out heart failure.</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Sputum culture and analysis</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Broncoscopy can be carried out in certain cases.</span></li>
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<p><b><span style="font-family: 'times' , 'times new roman' , serif"><span style="font-family: 'times' , 'times new roman' , serif"><span style="font-weight: normal">Treatment</span></span></span></b><br />
<span style="font-family: 'times' , 'times new roman' , serif"><span style="font-family: 'times' , 'times new roman' , serif"><span style="font-weight: normal">-Admission into intensive care unit for breathing support via Ventilator. </span></span></span><br />
<span style="font-family: 'times' , 'times new roman' , serif"><span style="font-family: 'times' , 'times new roman' , serif"><span style="font-weight: normal">-Antibiotic administration to fight infection.</span></span></span></p>
<p>*Prone position have been found to be appropriate in the management of ARDS.</p>
<p><b><i><span style="font-family: 'times' , 'times new roman' , serif"><span style="font-weight: normal">My Encounter with ARDS</span></span></i></b><strong><em> patient</em></strong><br />
<span style="font-family: 'times' , 'times new roman' , serif"><span style="font-family: 'times' , 'times new roman' , serif"><span style="font-weight: normal">I had to look after after a Mr. X diagnosed with ARDS and Intracranial hyperosmolar. It turned out to be a very busy and interesting shift. </span></span></span></p>
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<li><span style="font-family: 'times' , 'times new roman' , serif"><span style="font-family: 'times' , 'times new roman' , serif">Cardiovascular: Blood pressure was initially high but was supported with Noradrenaline infusion and it was managed. &#8211; </span></span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Respiratory: Was intubated and ventilated. Settings include: pressure control mode of 24, peep 14, FiO2 70%, respiratory rate 15, peak 38. The above high settings were changed slightly throughout the day. ABG revealed; high PCO2, low O2, high hydrogen</span>bi<span style="font-family: 'times' , 'times new roman' , serif">carbonate, high base excess, high sodium, low potassium and high glucose. All electrolytes were replaced and a slidiing scale was in place to control his blood glucose level.</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Neurologically, he was sedated and paralysed using Propofol and Actracurium infusions. Fentanyl was given for pain. Pupils were 2 and nonreactive. Richmond sedation agitation score was -5(deeply sedated and unarousable)</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif"><span style="font-family: 'times' , 'times new roman' , serif">Nutrition: on nasogastric feed- Nutrison and ng water at 40ml and 30ml respectively </span></span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Elimination: Good bowel movement and urine output. However, furosemide was given to push more fluid out of the lungs. </span></li>
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<p><span style="font-family: 'times' , 'times new roman' , serif">I hope you are getting the gist? I am not going to bore you with my nursing care bits. So, let me wrap it up by telling you the issues and plan for that day. </span><br />
<b style="font-family: Times, 'Times New Roman', serif">Problems:</b></p>
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<li><span style="font-family: 'times' , 'times new roman' , serif">ARD</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Septic shock</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Neutral fluid balance(off target)</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Electrolyte abnormalities</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Permissive hypercapnia</span></li>
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<div><b><span style="font-family: 'times' , 'times new roman' , serif">Plan:</span></b></div>
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<li><span style="font-family: 'times' , 'times new roman' , serif">PC Ventilator settings &#8211; sedated and paralysis</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Manual recruitment post sunctioning</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">No nebs &#8211; Suction 6hrly</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Ng water @ 30ml/hr</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Furosemide infusion Urine output greater than 100ml/hr</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Continue antibiotics Meropenem and Teicoplanin</span></li>
<li><span style="font-family: 'times' , 'times new roman' , serif">Discuss with microbiology daily.</span></li>
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<div><span style="font-family: 'times' , 'times new roman' , serif"><br />
</span><span style="font-family: 'times' , 'times new roman' , serif">Lastly, </span><span style="font-family: 'times' , 'times new roman' , serif">ARDS is a killer illness. </span><span style="font-family: 'times' , 'times new roman' , serif">I was practically on my feet throughout the shift as Mr. X was unstable and I had lots of infusions that were running out at different times amongst other tasks. Suctioning was quite scary that day as </span> Mr. X <span style="font-family: 'times' , 'times new roman' , serif">could desaturate</span><span style="font-family: 'times' , 'times new roman' , serif"> within secs. Oh! I ended up staying 45mins extra to do my documentations.</span></div>
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<p><b><span style="font-family: 'times' , 'times new roman' , serif">References </span></b><br />
<span style="font-family: 'times' , 'times new roman' , serif"><span style="font-family: 'times' , 'times new roman' , serif"><span style="font-weight: normal">NHS Choices (2015) </span></span></span></p>
<p><b>P.S.</b><br />
<span style="font-family: 'times' , 'times new roman' , serif">Thanks for reading. Sorry for the medical jargons- </span><span style="font-family: 'times' , 'times new roman' , serif"><i>I tried to minimse them. </i></span><span style="font-family: 'times' , 'times new roman' , serif">When your loved ones or friends are sick or look unwell, please encourage them to go the hospital to get a medical assistance.</span><span style="font-family: 'times' , 'times new roman' , serif">Ours lives are so precious. </span></p>
<p><span style="font-family: 'times' , 'times new roman' , serif"><span style="color: red">Disclaimer:</span></span><span style="font-family: 'times' , 'times new roman' , serif"> This cannot substitute for a professional medical advice and treatment. </span></p>
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Acute Respiratory Distress Syndrome
