Multi-Organ Dysfunction Syndrome Flashcards
def
a syndrome of progressive organ failure affecting one organ after another
what are causes of MODS
2Is and 2Hs Infection Injury Hypoperfusion Hypermetabolism
what is MODS also known as
multiple organ failure
aetiology
causes (2Is and 2Hs) trigger an inflammatory response
what is the progession to MODS
SIRS -> (+infection) -> sepsis -> septic shock -> MODS
what is the most common cause of MODS
sepsis (SIRS + infection)
what organs are progessively involved in MODS
respiratory failure (first)
Liver failure
GI bleeding
Kidney failure (last)
what are the four clinical phases of MODS score
stage 1
stage 2
stage 3
stage 4
what are features of stage 1 MODS score
respiratory failure (mild respiratory alkalosis) hyperglycaemia and increased insulin requirements
what are features of stage 2 MODS score
respiratory failure (tachypnoea with low CO2 and low O2) liver failure
what are features of stage 3 MODS score
kidney failure (azotaemia and acid-base disturbances)
what are features of stage 4 MODS score
requires vasopressers to maintain BP kidney failure (oliguric or anuric)
what is the sepsis six
six things to be done within one hour of diagnosis of sepsis to reduce mortality
3 IN -oxygen -empiral IV antiboitics -IV fluids 3 OUT -blood cultures -lactate and FBC -urine output
what is sepsis
life-threatening organ dysfunction caused by SIRS and infection
what is SIRS
systemic inflammatory response syndrome which ca result from infection, or non-infectious causes such as trauma or burns or pancreatitis)
what are the criteria for SIRS
any 2 of:
temp >38 or <36
HR >90bpm
>20RR or PaCO2 <4.3 (32mmHg)
WCC >12000/mm3 or <4000/mm3 or >10% immature
what is the criteria for sepsis
SIRS + infection
temp >38 or <36
HR >90bpm
>20RR or PaCO2 <4.3 (32mmHg)
WCC >12000/mm3 or <4000/mm3 or >10% immature
hyperglycaemia (>7.7) in the absence of DM
altered mental state
what is the criteria for severe sepsis
sepsis +
lactic acidosis
SBP <90 or drop of >40mmHg
what is the criteria for septic shock
severe sepsis with hypotension despite fluid resuscitation
what are features of MODS
evidence of >2 organs failing
epi
common in elderly
what are common causes of infection
bacteria most commonly
what is the most common cause of infection in sepsis
e coli
what group of bacteria causes most sepsis
gram positive (s aureus, enterococci and streptococci) cause more sepsis combined than gram negative (e coli, klebsiella, pseudomonas) however e coli is most common cause!!!
what is the most common fungal cause of sepsis
candida
what are risk factors for sepsis
elderly
malignancy or immunocompromised
any source of infection into the patient (haemodialysis, catheters, recent surgery)
what are features of sepsis
temp >38 or <36
tachycardiac
tachypnoea + low SATs
hypotension
signs associated with infection
what is purpura fulminans
widespread bleeding due to organ dysfunction
what causes purpura fulminans
pneumococcal septicaemia
how is sepsis diagnosed
clinical criteria for SIRS plus infection
what is the first thing that should be done when assessing sepsis
ABCDE and DEFG
what are the initial investigations for sepsis
1 identify causative organisms (blood cultures)
2 evaluate organ dysfunction (bloods - ABG, LFTs, FBC, coagulation, creatinine and urea and electrolytes + glucose)
3 identify source of infection (CXR)
4 to determine prognosis (lactate)
what marker is used for prognosis
lactate
