Multi-Organ Dysfunction Syndrome

Question 1

Define Multi-Organ Dysfunction Syndrome

Answer 1

Clinical syndrome characterised by development of progressive and potentially reversible physiological dysfunction in 2 or more organs or organ systems that is induced by a variety of acute insults (including sepsis)

Question 2

Define SIRS

Answer 2

Systemic inflammatory response syndrome = > 2 of the following:

• Temperature > 38 or < 36
• Heart rate > 90 bpm
• Respiratory rate > 20 bpm
• WBC count >12 x 109/L or < 4 x 109 / L or 10% immature forms (bands)

Question 3

Aetiology of SIRS

Answer 3

Infection
Pancreatitis
Ischaemia
Trauma
Tissue injury 
Haemorrhagic shock 
Autoimmune

Question 4

Define Sepsis

Answer 4

SIRS + culture-documented infection

SIRS that is from infection

Question 5

Define severe sepsis

Answer 5

Sepsis + organ dysfunction (renal, respiratory, hepatic, haematological, CNS, cardiovascular) ± DIC

Including (but not limited to) lactic acidosis, oliguria, acute mental status changes

Question 6

Define septic shock

Answer 6

Hypotension (despite fluid resuscitation) + Hypoperfusion

In septic shock, hypotension = SBP < 90 mmHg or reduction of >40 mmHg from baseline in absence of other causes

Question 7

Risk factors for MODS

Answer 7

Underlying malignancy 
Age >65
Immunosuppressed 
Haemodialysis
Alcoholism 
DM 
Recent surgery 
Breached skin integrity  
Indwelling lines or catheters
IVDU 
Pregnancy

Question 8

Signs of MODS

Answer 8

Temperature >38 or <36
Tachycardia >90
Tachypnoea >20
Acutely altered mental status
Signs of circulatory insufficiency: (Poor capillary refill | Mottling of skin | Ashen appearance | low SaO2 | Cyanosis)
Signs of the specific source of infection (e.g. Pneumonia: purulent sputum, dyspnoea, tachypnoea, cyanosis | Peritonism: abdominal pain, guarding, distension, tenderness, absent bowel sounds)
Arterial hypotension (SBP < 90mmHg, Mean BP < 65 mmHG or reduction in SBP > 40 mmHg from baseline)
Low urine output (<0.5ml/kg/hr)
Purpura fulminans (sign of organ dysfunction)
Jaundice or ileus (sign of organ dysfunction)

Question 9

Investigations for MODS

Answer 9

FBC
U+Es
Serum creatining
LFTs
Coagulation studies
Serum glucose
Lactate
CRP 
Blood cultures
ABG/VBG 
CXR

Question 10

What is the sepsis protocol

Answer 10

Sepsis 6:
Give 3: IV fluids, IV antibiotics, High flow oxygen
Take: blood cultures, lactate, urine output

TO BE COMPLETED WITHIN 3 HOURS OF TIME OF PRESENTATION

Obtain blood cultures (prior to antibiotic administration)
Administer broad spectrum antibiotics
Administer 30 ml / kg crystalloid for hypotension or lactate > 4 mmol / L