Acute and Emergency

Question 1

Form used by paramedics to hand over.

Answer 1

ATMIST

Question 2

Pathophysiology of angioedema.

Answer 2

Vascular Permeability: Both histamine and bradykinin increase the permeability of blood vessels, allowing plasma to leak into the interstitial spaces.

Fluid Extravasation: The leaked fluid accumulates in the deeper layers of the skin and mucous membranes, causing the characteristic swelling of angioedema.

Question 3

What is Multiorgan Dysfunction Syndrome (MODS)?

Answer 3

A severe, life-threatening condition where two or more organ systems in the body fail to function properly. This syndrome often requires intensive care and life support to manage.

Question 4

What are the possible causes of MODS?

Answer 4

• Sepsis
  
  • Major trauma
  • Burns
  • Pancreatitis
  • Surgery
  • Other causes include: heat stroke,
    poisoning, and autoimmune
    diseases.

Question 5

Pathophysiology of MODS.

Answer 5

The development of MODS involves a complex interplay of factors:

Inflammation: the body’s response to injury or infection can lead to widespread inflammation, affecting multiple organs.

Microcirculatory changes: changes in blood flow at the microscopic level can impair oxygen delivery to tissues.

Immune response: both overactive and suppressed immune responses can contribute to organ dysfunction.

Coagulation: abnormal blood clotting can occur, leading to further complications.

Question 6

Signs/symptoms of MODS.

Answer 6

The signs and symptoms of MODS can vary depending on the organs affected but can include:

Respiratory system: dyspnoea, hypoxemia, and acute respiratory distress syndrome (ARDS).

Cardiovascular system: hypotension, arrhythmias, and shock.

Renal system: reduced urine output and renal failure.

Hepatic system: jaundice and hepatic dysfunction.

Neurological system: confusion, altered mental status, and coma.

Question 7

Diagnosis of MODS.

Answer 7

Typically involves:

Clinical evaluation: assessing symptoms and medical history.

Laboratory tests: blood tests to evaluate organ function.

Imaging studies: X-rays, CT scans, and ultrasounds to visualise organ damage.

Question 8

Treatment of MODS.

Answer 8

Focuses on:
Supportive care: life support measures such as mechanical ventilation, dialysis, and medication to support heart function.

Treating the underlying cause: addressing the initial trigger, such as antibiotics for infections or surgery for trauma.

Monitoring and adjusting treatment: continuous monitoring in an intensive care unit to adjust treatments as needed.

Question 9

A 65-year-old male patient is admitted to the intensive care unit (ICU) after a severe road traffic accident. He has multiple fractures, significant blood loss, and has been intubated for respiratory support.

On the third day of hospitalisation, he develops a high fever, hypotension, and decreased urine output.

Laboratory tests reveal elevated liver enzymes, increased serum creatinine, and a high white blood cell count. Despite aggressive fluid resuscitation, his blood pressure remains low, and he requires vasopressor support.

Based on the clinical presentation, which of the following is the most likely diagnosis?

A. Acute Respiratory Distress Syndrome (ARDS)
B. Sepsis
C. Multi-Organ Dysfunction Syndrome (MODS)
D. Acute Kidney Injury (AKI)

Answer 9

Multiorgan Dysfunction Syndrome