急诊医学教学课件：Acute Respiratory Distress Syndrome.pptx

The Second Affiliated Hospital of Nanjing Medical University The Second Clinical Medical School of Nanjing Medical University;ASK QUESTIONS! ;Evidence-based medicine ;How do we practice EBM?;Where can I find an answer?;Knowing and acting;;;;;;;;First H7N9 infection case in Jiangsu 2014;Case;;;CTdependent alveolar edema and atelectasis;;;Questions;;World war 1 Wet lung;World war 2 Shock lung;Vietnam war Da nang lung;2003 SARSsevere acute respiratory syndrome;2009 H1N1 swine flu;June and September 2012;2013 H7N9avian flu ;;2015 avian flu again?;Physicians think they do a lot for a patient when they give his disease a name. --Immanuel Kant Shock lung Non-cardiogenic pulmonary edema Adult respiratory distress syndrome Acute lung injury Acute respiratory distress syndrome(?ARDS). None of these names provides any useful information about the condition. ;Outline;1.Definition*;What is syndrome?;Outline;2.Etiology;Etiology;2.Etiology*;2.1Direct Lung Injury;Aspiration of gastric contents;;Pulmonary contusion;Toxic inhalation injury;Near-drowning;2.2Indirect Lung Injury;Good?;Bad;Ugly;Severe trauma;Burns;Multiple transfusions;;Drug overdose;Pancreatitis;Post cardiopulmonary bypass;Outline;3.Pathology;Normal lung;Infant respiratory distress syndrome?(IRDS);IRDS vs ARDS;ARDS is the result of inflammation*;3.1 Inflammation;;3.2 Clinical Course;3.3 Pathologydiffuse alveolar damage**;3.3.1 Exudative Phase: fight;Diffuse alveolar damage ;;;;3.3.2 Proliferative Phase: repair;;3.3.3 Fibrotic Phase: scar;Fibrotic Phase:scar;Outline;4.Pathophysiology;4.1.Closed: Shunt;1. Why did this patient still have hypoxia after high flow of oxygen therapy?;4.2.Smaller:volume decrease;2. Why did we turn this patient to prone position?;;4.3.Harder:Compliance decrease;3. Why did this patient get pneumothorax? How to avoid that?;Why my balloon burst? ;Outline;5. DiagnosisOld Diagnostic Criteria for ALI and ARDS （not use）;Diagnostic Criteria for ARDS(2012)*;symptoms;Che