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Ms. P is a 75-year-old woman with weakness and hypotension.Ms. P has a past medical history of coronary artery disease (CAD), hypertension and diabetes. She complains of weakness, anorexia, nausea and vomiting. Her initial vitals signs demonstrate a pulse of 110 bpm and BP of 85/55 mmHg. She is having difficulty staying awake during the interview.

Ms. P has several features that suggest sepsis, including her fever, urinary symptoms, and leukocytosis. An ECG shows no acute changes and a serum troponin level is undetectable. Her blood glucose is 150 mg/dL. After a 2 L fluid resuscitation, Ms. P’s BP increases to 100/50 mm Hg, her skin is warmer, and her pulses are bounding. Antibiotics were started for empiric treatment of urosepsis. After initial stabilization, hypotension recurred and urinary output dropped. She was transferred to the ICU. Four hours later her oxygenation deteriorated and a chest film revealed a diffuse infiltrate consistent with acute respiratory distress syndrome.

She was intubated, cultures were drawn, and she was given IV fluids, norepinephrine, antibiotics, and mechanical ventilation. Her blood and urine cultures grew Escherichia coli. Over the next 24 hours, her BP stabilized. Seventy-two hours later she was extubated. She eventually made a full recovery.

 

S: Ms. P is a 75 yo female. Chief complaint of weakness and hypotension.

– complains of weakness, anorexia, nausea and vomiting.

-Difficulties staying awake during interview

-PMH – CAD, HTN , DM

 

O:  fever, urinary symptoms,

-blood glucose 150mg/dl,

 

-ECG shows no acute changes

– a serum troponin level is undetectable

– BP 85/55 mmHg

– 2l fluid resuscitation led to initial stabilization BP 100/50

 After initial stabilization

– drop in urinary output hypotension recurrence

 4hours later

– oxygen deterioration

– chest film revealed a diffuse infiltrate indication of ARDS

– Urine culture growth of Escherichia Coli

 

A:  fever, urinary symptoms, and leukocytosis: R/O  Sepsis, R/O Acute respiratory distress ARDS

       

P:

Transfer patient to ICU intubate and start mechanical ventilation,draw cultures, give IV fluids,norepinephrine, and antibiotics. Monitor patients progress.

 

Acute respiratory distress (ARDS):

ARDS is primarily caused by damage to the tiny blood vessels in your lungs. Fluid from these vessels leaks into the air sacs in your lungs. These air sacs are where your blood is oxygenated. When these air sacs fill with fluid, less oxygen gets to your blood.Hypotension and low blood oxygen can be indications of ARDS. Tests that should be performed include electrocardiogram and echocardiogram initially to r/o any heart condition. Chest X-ray or CT scan are helpful in revealing if lung air sacs are filled with fluid. A lung biopsy can also be taken as a confirmatory test to diagnose ARDS.

What can lead to ARDS?

 

inhaling toxic substances, such as salt water, chemicals, smoke, and vomit

 

  • developing a severe blood infection

  • developing a severe infection of the lungs, such as pneumonia

  • receiving an injury to the chest or head, such as during a car wreck or contact sports

  • overdosing on sedatives or tricyclic antidepressants

 

Who is more likely to suffer from ARDS?

  • smoking cigarettes

  • Age 65 or older

  • chronic lung disease

  • a history of alcoholism

People who

  • have toxic shock

  • are older

  • have liver failure

  • have a history of alcohol abuse

https://www.healthline.com/health/acute-respiratory-distress-syndrome#symptoms2