Question

G.S., a 56-year-old woman, was involved in a motor vehicle accident; a car drifted left of the center line and struck her head-on, pinning her behind the steering wheel. She was intubated immediately after extrication and flown to your trauma center. Her injuries were extensive: bilateral flail chest, right hemothorax and pneumothorax, fractured spleen, multiple small liver lacerations, open fractures of both legs, and a cardiac contusion. She was taken to the operating room for repair of her injuries. There she received 36 units of packed red blood cells, 20 units of platelets, 12 units of fresh frozen plasma, and 18 L of lactated Ringer’s solution. G.S. was admitted to the ICU postoperatively, where she developed acute respiratory distress syndrome (ARDS).

1. What is ARDS?

2. What are the risk factors for developing ARDS? Which does G.S. have?

3. With her extensive injuries, how was ARDS diagnosed?

4. Describe the collaborative care patients generally receive in the ICU for ARDS.

CASE STUDY PROGRESS

Answer 1

The patient had severe chest injury due to a road traffic accident following which she received a massive fluid and blood transfusion during surgery. Serious chest injuries including infections, aspiration,smoke inhalation, and trauma and massive transfusions can leads to acute respiratory distress syndrome (ARDS) .

1. Acute respiratory distress syndrome (ARDS) is a fatal condition in which respiratory failure occur due to fluid collection in the alveoli of lungs, leads to hypoxemia.

2. The common risk factors for development of ARDS

• History of lung disease and continuous oxygen therapy.
• Cigarette smoking and alcohol abuse
• Over weight
• Major surgeries especially involving cardiopulmonary system.
• Burns and massive blood transfusion
• Anaphylactic reactions.

The patient in this case has developed bilateral flail chest, right hemothorax and pneumothorax and cardiac contusion following motor vehicle accident and has undergone major high risk surgery and massive blood and blood product transfusion. These may be the risk factors to develop ARDS.

3. The patients with ARDS usually have severe breathing difficulty, low oxygen levels in the blood and cyanosis. The patient was intubated following the accident and undergone surgery. A chest radiograph or a CT scan can reveal the collection of excessive fluid in her lung tissue and confirm the diagnosis of ARDS.

4. The collaborative care patients generally receive in the ICU for ARDS.

1. Mechanical ventilation settings with low tidal volume to reduce further lung injuries.

2. Fluid management to avoid excess fluid in the body and further leake of fluid into the lung tissue.

3. Sedation and medications to make comfort to the patient on ventilator and careful use of diuretics to remove excess fluid from the body with close monitoring of blood pressure.