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MED SURG: SIRS and MODS

Terms in this set (16)

Systemic inflammatory response syndrome (SIRS)
-systemic response to a variety of insults with a generalized inflammation in other organs:
sepsis
ischemia
infarction
injury
**recognizes shock as it's happening
**body over exaggerates response and can make the situation worse
SIRS triggers
-trauma: burns, crush injuries, surgical procedures
-abscess formation
-ischemic or necrotic tissue: pancreatitis, MI, vascular disease
-microbial invasion: bacteria, virus, fungi
-endotoxin release: gram (-) bacteria
-global perfusion deficits
-regional perfusion deficits
SIRS criteria
*MUST HAVE AT LEAST 2 PRESENT*
temp <96.8 or >100.4
hr >90
rr >20 or PaCO2 <32
wbc <4,000
*draw a lactate lab if they have met at least 2 of these criteria*
SIRS criteria + known infection=
sepsis
multiple organ dysfunction syndrome (MODS)
-results from SIRS
-failure of 2 or more organ systems (homeostasis cannot be maintained without intervention
consequences of inflammatory response
Release of mediators
Direct damage to endothelium
Hypermetabolism
Increase in vascular permeability
Activation of coagulation cascade
organ and metabolic dysfunction
-hypotension
-decreased perfusion
-formation of microemboli
-redistribution or shunting of blood
respiratory patho
-alveolar edema
-decrease in surfactant
-increase in shunt
-V/Q mismatch
-end result: ARDS
cardiovascular patho
-myocardial depression and massive vasodilation
-results in decreased SVR and BP
-baroreceptors response to enhance CO
-albumin and fluid move out of blood vessels
neurologic patho
*often an early signs of MODS!
-mental status changes due to hypoxemia, inflammatory mediators or impaired perfusion
renal patho
-AKI
-hypoperfusion
-release of mediators
-activation of renin-angiotensin-aldosterone system
-nephrotoxic drugs, especially antibiotics
GI patho
-motility decreased: abdominal distention and paralytic ileus
-decreased perfusion: risk for ulceration and GI bleeding
-potential for bacterial translocation
-hypermetabolic!!
hypermetabolic state
-hyper or hypoglycemia
-insulin resistance
-catabolic state
-liver dysfunction
-lactic acidosis
-electrolyte imbalances
-metabolic acidosis
-increased hypoxia
-hematologic system (d-dimer)
MODS goals
-poor prognosis
-goal is to prevent progression of SIRS to MODS
-vigilant assessment and ongoing monitoring to detect early signs of deterioration or organ dysfunction are critical
-strict asepsis!!!
maintenance of tissue oxygenation
decrease O2 demand and increase O2 delivery:
-sedation (makes a decrease in O2 demand)
-mechanical ventilation
-analgesia
-rest
support of failing organs
ARDS: Aggressive O2 therapy and mechanical ventilation
DIC: Appropriate blood products
Renal Failure: Continuous renal replacement therapy or dialysis
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