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Critical Care Final > Multiorgan dysfunction > Flashcards

Multiorgan dysfunction Flashcards

1
Q

Endothelial Clells Function

A

“Cross Talk”

  • tell erythrocytes, platelets, leukocytes, and muscle cells what to do
  • release mediators
  • **REGULATE PERMEABILITY
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2
Q

Mediators:

  • released by
  • elicit
  • recruit
  • promote
A
  • endothelial cells
  • inflammatory response
  • WBC to area
  • localized clotting
    • contains the infection
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3
Q

Systemic Inflammatory Response Syndrome (SIRS)

A
  • systemic inflammatory response

- even in the absence of infection

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4
Q

What is the name of SIRS if an infection is present

A

Sepsis

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5
Q

What are common complications of SIRS

A

MODS- multi organ dysfunction system
ALI-
ARF-acute renal / resp. failure

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6
Q

Criteria for SIRS

A

pt has 2 of 4 s/s of SIRS

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7
Q

SIRS patho

A

inflammatory response is no longer contained and reaches uninvolved epithelial cells. Unregulated inflammatory response

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8
Q

Populations at risk for SIRS

A
  • > 65 y/o
  • trauma pt
  • alcohol and drug abusers
  • genetics that lead to infections
  • burn pts
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9
Q

S/S SIRS

A
  • temp >100.4
  • HR >90
  • RR >20 or PaCO2 12,000 or 10% immature cells (bands)
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10
Q

Clinical conditions associated with SIRS

A
  • infection
  • pancreatitis
  • ischemia
  • shock
  • trauma
  • exogenous administration of cytokines
  • aspiration
  • massive transfusions
  • host defense abnormalities
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11
Q

MODS

A

-failure of 2+ organs

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12
Q

MODS:

what is client outcome associated with?

A

assoc with number of organs that fail with mortality increasing 15-20% with failure of each organ

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13
Q

MODS:

mortality of 80-100% failure

A

3+ organ failure

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14
Q

MODS:

who have the highest susceptibility?

A

Sepsis and Trauma pts

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15
Q

PRIMARY MODS

A
  • results from a well defined insult

- result of inadequate oxygenation delivery to cells and a failure of microcirculation to remove metabolic end products

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16
Q

PRIMARY MODS

-causes

A
  • Trauma
  • pulmonary contusion
  • aspiration
  • renal dysfunction
  • thermal injury
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17
Q

SECONDARY MODS

A

consequence of widespread systemic inflammation

-involves other organs and is not defined

18
Q

SECONDARY MODS:

-result of

A
  • late organ dysfunction

- result of generalized SIRS or sepsis

19
Q

Pathologic changes with MODS

A
  • uncontrolled systemic inflammation
  • tissue hypoxia
  • unregulated cell death
  • microvascular coagulopathy
20
Q

Inflammatory Cells

A 
neutrophils
macrophages
mast cells
lymphocytes
endothelial cells
21
Q

**Inflammatory cell functions

A

Produce and release mediators

22
Q

Plasma protein synthesis

A

Complement
kinin
coagulation

23
Q

FUNCTIONS: **Leukotrienes
Bradykinin
Prostaglandins
Oxygen free radicals

A

affect vasomotor tone and vascular permeability

24
Q

FUNCTIONS: **

Interleukins

A

Cytokine that causes vascular congestion, capillary leakage, and increased coagulation

25
Q

FUNCTIONS**

Platelet Activating Factor

A

phospholipid that release serotonin which increases vascular permeability

26
Q

FUNCTIONS**

Tumor Necrotic Factor

A

Polypeptide that stimulates clotting cascade and causes DIC permeability

27
Q

FUNCTIONS**

Protease

A

Proteolytic enzyme that damage endothelium and contribute to vascular permeability and organ dysfunction

28
Q

Factors affecting ScVO2

-CO

A

HR
volume
Resistance
Pump

29
Q

Factors affecting ScVO2

-SaO2

A

Oxygenation
FiO2
Ventilation

30
Q

Factors affecting ScVo2

-Hb

A
  • bleeding
  • hemodilution
  • anemia
31
Q

Factors affection ScVO2

-VO2

A

shivering
fever
seizures
muscle activity

32
Q

Why should we measure intra-abdominal pressures

A

abdominal pressures put pressure on the other vital organs–> edema and compresses vena cava

33
Q

Normal value: intra-abdominal pressures

A

0-11

34
Q

IAP 12-15

A

Increasing physiologic compromise

  • incr. SVR
  • SOB
  • dec. gut perfusion
  • poor healing
  • DVT
  • dec. UO
  • venal cava compressed
  • Decr. preload
  • Dec. CO
35
Q

IAP 16-20

A

Occult Organ Ischemia

  • INCREASED ICP & DECR. CPP
  • bowel ischemia/ edema
  • acidosis
  • oliguria
  • Incr. CVP and wedge pressure
36
Q

IAP >20

A

Onset of MODS

  • BRAIN SWELLING AND ISCHEMIA
  • CARDIOVACULAR INSTABILITY
  • ARDS
  • necrosis of bowel
  • Renal failure
  • flat vena cava
37
Q

PInterventions to decrease IAP

A

Reverse trendendelberg

  • remove constrictions
  • assess fluids
  • neutral to negative fluids in 3 days
  • NG tube
  • Rectal tubes
  • enemas
38
Q

what meds given to decrease IAP

A

Prokinetic agents:
erythromycin and metoclopramide
–> promote GI mobility

39
Q

where to level transducer for IAP

A

at iliac crest

40
Q

Treatment of MODS

A
  • fluids
  • hemodynamic support (inotropes, antidysrhythmics, vasopressors)
  • prevent and treat infection
  • tissue oxygenation
  • nutritional support
  • comfort

Critical Care Final (5 decks)

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