Rigid Rita — ARDS
Refractory hypoxemia, stiff lungs, white-out on x-ray
Rita survives the sepsis that started it all, then her lungs turn to concrete. The x-ray goes white from edge to edge and every liter of oxygen she gets seems to disappear.
Rita's lungs stiffen and flood 24–48 hours after a major insult. The hallmark is refractory hypoxemia — the PaO₂ will not rise no matter how much oxygen you give. Low tidal volume ventilation, PEEP and prone positioning are the answers.
Read Rigid Rita's full story →The story arc
The setup
Rita is recovering from severe pancreatitis when her respiratory rate creeps up.
The turn
Within 24 hours she needs a non-rebreather, and her SpO₂ still sits at 85%.
The crisis
Chest x-ray shows bilateral white-out infiltrates with no heart failure to explain it. Her lungs are stiff and hard to bag.
The save
She is intubated on low tidal volumes (6 mL/kg) with high PEEP, sedated, and turned prone for 16 hours a day.
NCLEX study section — ARDS
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Respiratory
Take this chapter into practice questions on the same topic.