NUR401 Case Study: Acute Respiratory
Distress Syndrome (ARDS) 56yrs Car
Accident
Scenario: Rocky is a 56 y.o. aeronautical scientist who was involved
... [Show More] 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 hemopneumothorax, 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 non-cardiac
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?
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NUR401 Case Study: Acute Respiratory
Distress Syndrome (ARDS) 56yrs Car
Accident
• 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.
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NUR401 Case Study: Acute Respiratory
Distress Syndrome (ARDS) 56yrs Car
Accident
• Assist control delivers a fixed volume regardless of
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NUR401 Case Study: Acute Respiratory
Distress Syndrome (ARDS) 56yrs Car
Accident
whether it was triggered by the patient or the ventilator.
If the client does not initiate a breath before period of
time determined by the set respiratory rate, the vent will
deliver set tidal volume.
5. What is the PEEP doing for Rocky? What is a complication of the
PEEP level so high? Describe clinical findings associated with this
complication.
• The PEEP setting helps keep the alveoli open during
expiration by increasing pressure in the alveoli which in
return increases the surface area giving the alveoli more time [Show Less]