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What is the current definition of ARDS?
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1. Acute onset2. Bilateral infiltrates on CxR3. PCWP < 18 or lack of clinical evidence of heart failure4. PaO2/FiO2 ratio < 200. If < 300, then condition is acute lung injury (ALI).
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ARDS and ________ can co-exist
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Heart failure
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How good are physicians at estimating whether someone is volume overloaded or not?
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Attendings are minimally better than residents; clinical judgment is not very accurate
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What are the traditional criteria for ruling out heart failure when trying to dx a case of ARDS?
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1. Pulmonary artery wedge pressure < 18 (measure with Swan-Ganz catheter)2. No other evidence of left atrial hypertension
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What else can be done to rule out heart failure?
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Normal cardiac function by echocardiography
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What are the radiographic features of ARDS?
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Alveolar infiltrates that are patchy, bilateral, and asymmetric with areas of atelectasis that are seen on CT scan and CXR
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What are the pathologic features of ARDS?
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Diffuse alveolar damage with inflammatory cells, hyaline membranes and protein-rich edema fluid in the alveoli
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What is pathognomonic for ARDS?
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Diffuse alveolar damage and hyaline membranes
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What does a hyaline membrane look like on a tissue biopsy?
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It is a lighter pink area with no cells; lines the alveolar spaces, won't see any nuclei b/c it's just collagen deposits
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Hyaline membrane = _________
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Dead pneumocytes and collagen
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What are the 2 major causes of ARDS?
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1. Direct lung injury2. Indirect lung injury
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What is the most common direct lung injury causing ARDS?
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Pneumonia
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What is the most common indirect lung injury causing ARDS?
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Sepsis
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What is the second most common direct lung injury causing ARDS?
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Aspiration of the gastric contents
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What is the second most common indirect lung injury causing ARDS?
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Severe trauma with shock.
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