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Terms in this set (53)
Type of MODS?
Caused by Transfusion, Infection, multiple surgical procedures.
Type of MODS?
Exaggerated Inflammatory Response
Type of MODS?
Injury may occur distant from the initial insult
The initial insult may be MINOR
Type of MODS?
Occurs based on the direct result of one defined event
Type of MODS?
Occurs from Major Trauma, Shock, Major Burns
MODS is the dysfunction of...
2 or more organs
What involves the Quick SOFA Bedside Assessment?
2 or more indicate..
RR 22/min or higher
SBP <100 mm Hg
2 or more of these indicate poor outcomes more related to Sepsis
Septic Shock is defined by..
Vasopressor needed to maintain MAP 65 mm Hg AND
Lactate level greater than 2 mmol/L IN THE ABSENCE OF HYPOVOLEMIA
2 good indicators of Sepsis
1 bad indicator of Sepsis
Skin Color Changes
BAD: Hypotension comes later in children than adults - need to treat prior to hypotension
How soon should you start the Sepsis Resuscitation Bundle?`
Within 6 hours
What does the Sepsis Resuscitation Bundle include? 6
Blood Cultures X 2 BEFORE Abx
Give Early Abx Admin
Fluid resuscitation if hypotension or elevated lactate
Vasopressin to keep MAP above 65
CVP adequate to maintain Preload
Conditions Predisposing to MODS:
Inadequate fluid resuscitation
Multiple Blood Transfusions
Persistent Infectious Process
What are the 3 I's that lead to the inflammatory response?
If the response is dysregulated to infection it can lead to
Components of SOFA and their Labs
Renal (Creatinine, U/O/day)
The Pulmonary Symptoms include:
The failure is....
The symptoms are...
Tachypnea, Hypoxia, Fatigue
ARDS: RR>40, Crackles/Wheezing, Pulm Edema, Copious secretions, labored breathing
Renal Symptoms are...what type of renal cause?
The Failure is...
Increased BUN/Creatinine, Oliguria
PRE Renal Cause
Tachycardia, Edema, Decreased CO, Decreased MAP from Hypotension
Mottled fingers and toes
Inotropes include which meds and they do what
Dopamine and Dobutamine
Increase contractility and heart rate
Vasopressin include which meds and they do what?
Dopamine, Epinephrine, Norepinephrine
Increase MAP (Preload) by increasing blood pressure, heart rate.
Hepatic Problems and their Symptoms include:
Increased Ammonia - decreased LOC
Decreased Albumin - Edema
Increased Bilirubin - Jaundice
Increased Bleeding from low clotting factors
Increased LFT, Prolonged PTT
Bleeding and clotting (Thrombi, Bleeding)
Decreased platelets, decreased fibrinogen, increased D-Dimer
Central Nervous System symptoms include...
Failure: COMA, SEIZURE, ASPIRATION, FALLS
Gastroparesis: delayed bowel emptying
Inability to tolerate enteral feedings
The failures that occur with Hepatic are..
Ascites, Encephalopathy, Jaundice
The drug given for high ammonia is ...
Lactulose, binds ammonia
The 4 MAIN s/s of Hepatic are...
AMMONIA: decreased LOC
Prolonged aPTT, elevated LFT; bleeding
High bilirubin: JAUNDICE
Complications of Hematologic issues?
DIC, Thrombosis, Bleeding
Central Nervous System dysfunctions:
Restless, Anxiety, Agitation, Confusion
Risk of CNS:
Seizures, Coma, Fall, Aspiration
What are the CARDIAC dysfunctions?
Myocardial Depression - decreased CO
Leaky capillaries leading to edema
What are CARDIAC complications?
Anarasarca, widespread edema
Mottling of hands/feet
What is the MAP in MODS?
Less than 70
THE MAP and AFTERLOAD
By vasoconstricting the vessels and raising BP
What are the Renal FAILURES?
Acute Tubular Necrosis
What is the solution to the Renal problems?
get weight, i/o, labs, bladder scan
What are the Renal SYMPTOMS/SIGNS
What are the Pulmonary Symptoms?
What are the Pulmonary Complications?
Noncardiogenic pulmonary edema
Crackles and Wheezing
What type of damage/cause is the Renal Failure?
It is PRE RENAL
The Dysfunction that occurs in MODS occurs on a ....
A ____________ rather than an _____________
It is a proinflammatory response precipitated by a nonspecific insult.
Systemic Inflammatory Response Syndrome
An infectious process that triggers a systemic response that, if severe, can result in MODS.
When Infection is the underlying cause, it is
Host response to toxins produced from SIRS
The Secondary type of MODS
Major Trauma, Burns, or Shock are risk factors for
The Primary MODS
Multiple surgical procedures, transfusion, or infection are risk factors for
Secondary MODS involves organs ___________ from the initial insult, the insult may have been ____________
What are the 4 components of the Inflammatory Response?
VASODILATION: to allow nutrient delivery and cellular access to site of injury
VASCULAR PERMEABILITY: to allow cellular access
COAGULATION: Prevent blood loss and wall off injury
ACTIVATION OF COMPLEMENT SYSTEM: Stimulates phagocytosis, wound healing, host protection
What happens to 4 Components in MODS?
Vasodilation leads to HYPOTENSION
Vascular Permeability leads to EDEMA
Coagulation leads to MICROTHROMBI
Complement System leads to unregulated apoptosis and thus PERSISTENT INFLAMMATION
The response to MODS Pathophysiology activates the...
Sympathetic Nervous System Stress Response
Hypothalamus -- Pituitary -- Adrenal Gland -- Cortisol (Cortisol, Glucagon, Glucocorticoids)
What comprises the QUICK SOFA assessment tool?
RR > 22/minute
SBP below 100 mm Hg
Definition of Septic Shock:
Vasopressor to maintain MAP of 65
Lactate level > 2 in the absence of hypovolemia
Name the components of the Sepsis Resuscitation Bundle:
1. Lactate Level
2. Blood Cultures TWICE before giving Abx
3. Early Abx
4. Fluid Resuscitation if hypotensive OR elevated lactate level
5. Maintain CVP/Preload
6. Vasopressins to maintain MAP of 65 (Afterload)
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