ARDS: Phases (Nursing)

00:01 We've divided the phases of ours into about three categories.

00:05 Now, you can spend a lot of time arguing that these there's a lot of debate about what goes where and exactly when.

00:11 But I'm just going to give you a rough range.

00:13 Okay, there's three phases.

00:16 Sometimes people call them stages.

00:18 You may call them whatever you like.

00:20 Let me give you an overview.

00:22 The first phase is often called the injury or exudative phase.

00:27 Now, it usually last one to three days.

00:30 But it can last up to seven days.

00:33 I know that can be overwhelming, as a student like so, is it 1? Is it 3? Is it 7? That's the deal with ARDS.

00:40 Not everyone progresses through it at the same phase, or at the same rate or in the same number of days.

00:47 That's why we're giving you reference ranges.

00:50 So first of three phases, the injury or the exudative phase.

00:55 Next up, you'll see we've got 7 to 14 days.

00:58 This is called reparative or proliferative phase.

01:03 Reparative or proliferative phase.

01:06 Reparative or proliferative phase.

01:10 Yeah, that was repetitive because there's a lot going on here.

01:14 So I want you to know that these 7 to 14 days, cells are just going crazy.

01:20 We got a lot of things happening in here.

01:22 So we're going to spend time in both of these first two categories.

01:27 The last category is called the fibrotic, or the chronic/late phase.

01:32 This is what not everyone ends up stuck here, right.

01:36 But this is a bad deal.

01:37 We've gone on past a couple weeks, but lung tissue is really been replaced with fibrotic tissue.

01:44 Remember why that's a bad deal because we're talking about compliance, right? Recoiling fibrotic tissue is not very compliant.

01:56 So it's not very efficient.

01:59 So we've used repetition, but let's go back through it First phase, injury or exudative.

02:05 Second phase, reparative or proliferative.

02:09 Third phase, fibrotic and remember not everyone gets stuck there.

02:14 But sadly some people do, because ARDS does have a certain mortality rate.

02:20 Now we argue about it in the literature.

02:22 This study has this one, this study has that one.

02:24 Let me just tell you this can be a life-threatening and an life-ending event for your patient.

02:31 So let's just take it serious.

02:32 We won't argue about the actual numbers of what the mortality rate is and let's just know we've got to do our best to respond to this urgent crisis.

02:42 Let's serious talk.

02:44 Let's just talk about something that you can pull out of your knowledge.

02:48 So let's talk about the three important things for effective gas exchange in the alveoli.

02:53 If you've been hanging out with us in this video series, you already know this.

02:57 But let's just use this as a review.

03:00 Now the picture is a hint.

03:02 It's a really big clue.

03:04 What's in this picture that helps you know? What are the three important things for effective gas exchange in the alveoli, okay? So first, intact alveolar walls, huh? This is sounding familiar, right? Intact alveolar walls with two types of epithelial cells (type l and type ll).

03:26 Remember type l, the elegant CO2O2 exchange.

03:31 Type ll, our cuboidal surfactant spitter outers.

03:34 There you go.

03:35 So we need an intact alveolar wall.

03:38 We need an intact capillary wall of endothelial cells.

03:43 And we need surfactant to reduce surface tensions.

03:47 Hey, so same thing we needed for compliance.

03:51 Exactly, when the lung is functioning effectively, it has the intact alveolar wall, intact capillary wall and it has surfactant that both allows the lung to be.

04:03 Compliant and have effective gas exchange in the alveoli.

04:09 You got it, good deal.