Shock part 4 (SIRS, MODS) Flashcards
What does SIRS stand for?
Systemic inflammatory response syndrome
Define SIRS
Inflammatory syndrome that is widespread and affects the whole body in response to an infection that is related to sepsis
What is the criteria standard components for SIRS?
Temperature
Heart rate
Respiratory rate
Wbc count
SIRS temperature requirements
Greater than 100.4 F
or
Less than 96.8 F
SIRS heart rate
Greater than 90
SIRS respiratory rate
Greater than 20 breathes
SIRS white blood cell count requirements
Greater than 12,000
Complications of SIRS
ARDS of lungs
Acute Kidney injury
Shock
Mods
What is MODS?
Multiple organ dysfunction syndrome of 2 or more organs
T/F
MODS is a chronic issue
False. It is acute
Will a patient with MODS have pressures and rates than can be controlled by meds?
No. This is when they are maxed out and its not helping. No intervention is working. Hanging on barely. No homeostasis regardless
Stage 1 of MODS volume requiremnts?
Increased volume requirements to have any minimal perfusion left.
Will stage 1 of MODS have respiratory alkalosis or acidosis?
Mild respiratory alkalosis with stage 1 MODS
What assessment symptoms occur in stage 1 of MODS? And the intervention that correlates with it?
Oliguria (decrease UO) so they need more fluids
Hyperglycemia and increased need for insulin
Summarize stage 1 of MODS
Increased fluid requirements
Respiratory alkalosis
Oliguria
Hyperglycemic
More insulin needs
Stage 2 of MODS breathing rate?
Stage 2 has tachypneia, fast breathing
Stage 2 of MODS Co2 levels? What does this do to vessels?
Hypocapnic which is related to constriction of vessels
Stage 2 MODS blood?
Blood is hypoxemia
Stage 2 MODS organ dtysfunctioning?
Moderate liver dysfunction
- check labs
Summarize stage 2 of MODS
Tachypnea
Hypocapnic
Hypoxemic
Moderate liver dysfunction
What is Azotemia?
Abnormally high levels of nitrogen contained compounds (urea, creatinine, waste) in the blood due to the kidneys not filtering them out
What stage of MODS has Azotemia?
Stage 3 MODS
What labs do you check for with stage 3 MODS?
Look for ABG disturbances
Check the coagulation studies for abnormalities for DIC
What will bowel sounds be like if your assessing a MODS stage 4 patient
Hypoactive x4 because they will be anuric and have ischemic colitis
Summarize stage 3 of MODS
Azotemia rt bad kidneys
Acid base disturbances
Coagulation issues like DIC
If a patient is in stage 4 of MODS what are they dependent on?
They are dependent on vasopressors
What will lactic acid levels be like with a MODS stage 4 patient?
Lactate greater than 2 (hypoperfusion)
Summarize stage 4 of MODS
Dependent on vasopressors being maxed out
Anuric
Ischemic colitis
Lactate greater than 2
What will the systolic BP of your MODS patient be?
Systolic blood pressure will be less than 90
What will MAP be for a MODS patient?
MAP will be dropped less than 70 despite resuscitation
What meds do we use for cardiogenic shock?
Milrinone
Dopamine
Dobutamine
What meds do we use for cardiogenic shock?
Milrinone
Dopamine
Dobutamine
The inotropes
PaO2/FiO2 requirements for MODS?
They will need more and more oxygenation.
Peep requirements for MODS?
It’ll be higher than 7.5 going up to 10-12. peep.
What happens to renal/output in MODS?
Urine output will be less than the 0.5ml/kg/hr
CR will increase 50%
They will need to have that CRRT dialysis
What will platelets be like in MODS?
Platelets below 100,000
PT/PTT will be upper limit of normal
- need to pay attention due to anticoagulation therapy
Metabolic labs for MODS
Low ph so below 7.30
High lactate greater than 2
Hepatic labs for MODS
Liver enzymes greater than 2x upper limit of normal
Jaundice, scelera, anemia
CNS assessment of MODS patients
Altered LOC
Decrease Glasgow coma scale
- 15 is normal , 8 intubate
- if you don’t know the baseline, find out from family
