Fast Five Quiz: Acute Respiratory Distress Syndrome (ARDS)

Zab Mosenifar, MD

Disclosures

April 10, 2020

ARDS is characterized by the development of acute dyspnea and hypoxemia within hours to days of an inciting event, such as development of COVID-19, trauma, sepsis, drug overdose, massive transfusion, acute pancreatitis, or aspiration. In many cases, the inciting event is obvious, but in others (eg, drug overdose), it may be harder to identify.

Physical findings often are nonspecific and include tachypnea, tachycardia, and the need for a high fraction of inspired oxygen (FiO2) to maintain oxygen saturation. The patient may be febrile or hypothermic. Because ARDS often occurs in the context of sepsis, associated hypotension and peripheral vasoconstriction with cold extremities may be present. Cyanosis of the lips and nail beds may occur.

Examination of the lungs may reveal bilateral rales. Rales may not be present despite widespread involvement. Because the patient is often intubated and mechanically ventilated, decreased breath sounds over one lung may indicate a pneumothorax or endotracheal tube down the right main bronchus.

Because cardiogenic pulmonary edema must be distinguished from ARDS, carefully look for signs of congestive heart failure or intravascular volume overload, including jugular venous distention, cardiac murmurs and gallops, hepatomegaly, and edema.

Read more about the presentation and physical examination findings of patients with ARDS.

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