Acute Respiratory Distress Syndrome (ARDS)

Question 1: What are some causative factors in this case that could produce ARDS? 

ARDS occurs in the process of fluids building up tiny and elastic air sacks in a person's lungs. The fluids play the role of keeping the lungs from being filled up with enough air that implies that a person gets less oxygen in the bloodstream. From this case critical illness such coma can lead to a shortage of breadth. Despite the fact that she has never smoked, it might be possible that she experienced indirect injuries of the lung such as burns, severe infection, medical reactions, and inflammation of the pancreas or blood transfusion. 

Question 2: Once you receive the full report about the patient what do you think should not have happened? 

In my opinion, the 48 years woman in the comatose state could have not been sedated or brought into an emergency room to avoid the outspread of the disease. The aims of sedation are to provide the patients with improved comfort and supportive tolerance coupled with therapeutic measures that do not escalate into adverse repercussions. In my opinion, sedation is associated with a longer stay in the emergency room or ICU which exposes risk to the ill patients and increases their chances of death. 

Question 3: Interpret the ABG 

According to the report, the PH is estimated to be 7.3, by using the procedure that if the PH< 7.35, academia is present and when the PH > 7.45 alkalemia is present, we= can then deduce from the procedure that acidemia or acidocis is present. The interpretation will extend to testing whether there is a metabolic or respiratory disturbance. In testing the primary respiratory disorder the PaCO2 and PH changes occur in opposite direction whereas the metabolic disorder the PaCO2 and PH experiences changes in the same direction. 

Since PaCO2 is 52 which shows high acidosis nature and the PH is 7.3 which is also acidosis in nature, we can deduce that the compensated respiratory is acidosis. This is supported by the fact that even though there is high PaCO2 indicating Acidosis with the PH lying in the normal range that clearly suggests that the metabolic component has occurred and has caused the PH to exhibit a shift towards the midpoint estimated as 7.4. Since the HCO3 is 25 and the PH is 7.3, it is likely to suggest that it is a metabolic acidosis respiratory with respiratory compensation bring the pH close towards mid point but not back to WNL. 

Question 4: What would be your first respiratory assessment based on what has been presented to you ? 

Interpreting ABG “arterial blood gas” is an important skill to respiratory therapist, nurses, physicians, and health care personnel. As from this case, the information presented will render someone to initially test the internal consistency of the values. This is often solved by using an equation of Henderseon-Hasselbach. Besides, it is first assessed to determine whether the (H+) or PH are consistent or if ABG is a valid method. 

Question 5: Would you agree the patient is in acute ventilatory failure? Is so why or why not? What signs and symptoms lead you to this diagnosis? 

In my opinion, the 48 years old woman in the comatose state has experienced acute ventilation failure. This is supported by the presence of SaO2 % estimated at 80%. Since every patient requires mechanical ventilation to improve oxygenation and lowers oxygen demand by keeping at bay the respiratory muscles. Thus, the mechanical ventilation targets a reduced Fio2 to keep up adequate SaO2 to reduce all the present oxygen toxicity. 

Question 6: Based on your assessment, what will you do at this time? 

At this time I will develop a rescue strategy suppose the conventional treatment fails. So, I will apply prone positioning as s strategy to care for the ARDS patient by exploring various roles of inventions such as neuromuscular blockade. 

Question 7: What does chest x-ray show? 

Chest X-ray shows that the 48 woman suffers a severe ARDS in its early stages. This is likely to happen in non-invasive ventilation. The X-ray shows the presence of diffuse infiltrates, inhomogeneous or homogenous, and bilateral infiltrates displayed on the frontal Chest X-Ray that evokes fluids to accumulate around the alveolar barrier. The pattern formed indicates ARDS anatomopathological symptoms coupled with hyaline membrane leads to diffuse alveolar damage. The diffuse bilateral opacities constitutes of the image that is white in color. Besides, the lung volumes seem dramatically reduced to pose risk to mechanical ventilation. 

Question 8: What would you change to her therapy? 

In my view, the changes I will make in her therapy is that I shall apply prone positioning which shall lead to a redistribution of lung densities. This technique shall lead to improving the ventilation-perfusion matching and reduce the alveolar shunt. This is the best alternative therapy that should be considered at the early stages of severe ARDS. 

Question 9: Interpret new ABG values 

For this result PaCO2 is 48 which shows high acidosis nature and the PH is 7.32 which is also acidosis in nature, we can deduce that the compensated respiratory is acidosis. This is supported by the fact that even though there is high PaCO2 indicating Acidosis with the PH lying in the normal range that clearly suggests that the metabolic component has occurred and has caused the PH to exhibit a shift towards the midpoint estimated as 7.4. Since the HCO3 is 23 and the PH is 7.32, it is likely to suggest that it is a metabolic acidosis respiratory with respiratory compensation bring the pH close towards midpoint but not back to WNL 

Question 10: What would be your next step in handling respiratory therapy? 

.As from this case, the next step in handling respiratory therapy information will render someone to first test the internal consistency of the values. 

Question 11: What other measures do you think can be done for this patient? 

The patient can be given the rescue therapies such as muscle paralysis, extracorporeal membrane oxygenation, and prone positioning. 

Question 12: Do you think the patient change in condition could have been prevented? If so, why? 

The changes in patient’s conditions could have been prevented by identifying the risk through lung injury prediction to know the status of the patient. 

Question 13: What would you recommend at this time? 

In conclusion, the current management should incorporate prediction scores to allow the physician to identify the risk exposed to ADRS. Additionally, they should use inhaled formoterol and clinical trial testing aspirin.