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Acute respiratory distress syndrome (ARDS) diagnostic criteria = within 1 week of insult; bilateral opacities consistent with pulmonary edema on chest imaging; respiratory failure not due to heart failure or volume overload; arterial PO2/FiO2 ratio <300 and minimum PEEP of 5 cm H2O)

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ARDS severity is based on arterial PO2/FIO2 ratio → mild = 201-299, moderate = 100 – 200, severe = <100

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ARDS can be caused by trauma; differentiate from diffuse alveolar hemorrhage by falling hemoglobin level + appearance of new focal or diffuse infiltrates, sometimes hemoptysis (in alveolar hemorrhage)

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Pulmonary embolism → chest pain, dyspnea, tachypnea; CXR is usually normal but may show wedge-shaped opacities in the peripheral lung

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In acute respiratory failure with suspected ARDS, rule out acute cardiogenic pulmonary edema (jugular venous distension, S3 sound, peripheral edema; EKG, Echocardiogram, pro-BNP, serial troponins)

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