Shock part 4 (SIRS, MODS)

Question 1

What does SIRS stand for?

Answer 1

Systemic inflammatory response syndrome

Question 2

Define SIRS

Answer 2

Inflammatory syndrome that is widespread and affects the whole body in response to an infection that is related to sepsis

Question 3

What is the criteria standard components for SIRS?

Answer 3

Temperature

Heart rate

Respiratory rate

Wbc count

Question 4

SIRS temperature requirements

Answer 4

Greater than 100.4 F

or

Less than 96.8 F

Question 5

SIRS heart rate

Answer 5

Greater than 90

Question 6

SIRS respiratory rate

Answer 6

Greater than 20 breathes

Question 7

SIRS white blood cell count requirements

Answer 7

Greater than 12,000

Question 8

Complications of SIRS

Answer 8

ARDS of lungs

Acute Kidney injury

Shock

Mods

Question 9

What is MODS?

Answer 9

Multiple organ dysfunction syndrome of 2 or more organs

Question 10

T/F

MODS is a chronic issue

Answer 10

False. It is acute

Question 11

Will a patient with MODS have pressures and rates than can be controlled by meds?

Answer 11

No. This is when they are maxed out and its not helping. No intervention is working. Hanging on barely. No homeostasis regardless

Question 12

Stage 1 of MODS volume requiremnts?

Answer 12

Increased volume requirements to have any minimal perfusion left.

Question 13

Will stage 1 of MODS have respiratory alkalosis or acidosis?

Answer 13

Mild respiratory alkalosis with stage 1 MODS

Question 14

What assessment symptoms occur in stage 1 of MODS? And the intervention that correlates with it?

Answer 14

Oliguria (decrease UO) so they need more fluids

Hyperglycemia and increased need for insulin

Question 15

Summarize stage 1 of MODS

Answer 15

Increased fluid requirements

Respiratory alkalosis

Oliguria

Hyperglycemic

More insulin needs

Question 16

Stage 2 of MODS breathing rate?

Answer 16

Stage 2 has tachypneia, fast breathing

Question 17

Stage 2 of MODS Co2 levels? What does this do to vessels?

Answer 17

Hypocapnic which is related to constriction of vessels

Question 18

Stage 2 MODS blood?

Answer 18

Blood is hypoxemia

Question 19

Stage 2 MODS organ dtysfunctioning?

Answer 19

Moderate liver dysfunction

• check labs

Question 20

Summarize stage 2 of MODS

Answer 20

Tachypnea

Hypocapnic

Hypoxemic

Moderate liver dysfunction

Question 21

What is Azotemia?

Answer 21

Abnormally high levels of nitrogen contained compounds (urea, creatinine, waste) in the blood due to the kidneys not filtering them out

Question 22

What stage of MODS has Azotemia?

Answer 22

Stage 3 MODS

Question 23

What labs do you check for with stage 3 MODS?

Answer 23

Look for ABG disturbances

Check the coagulation studies for abnormalities for DIC

Question 24

What will bowel sounds be like if your assessing a MODS stage 4 patient

Answer 24

Hypoactive x4 because they will be anuric and have ischemic colitis

Question 25

Summarize stage 3 of MODS

Answer 25

Azotemia rt bad kidneys Acid base disturbances Coagulation issues like DIC

Question 26

If a patient is in stage 4 of MODS what are they dependent on?

Answer 26

They are dependent on vasopressors

Question 27

What will lactic acid levels be like with a MODS stage 4 patient?

Answer 27

Lactate **greater** than 2 (hypoperfusion)

Question 28

Summarize stage 4 of MODS

Answer 28

Dependent on vasopressors being maxed out Anuric Ischemic colitis Lactate greater than 2

Question 29

What will the systolic BP of your MODS patient be?

Answer 29

Systolic blood pressure will be **less** than 90

Question 30

What will MAP be for a MODS patient?

Answer 30

MAP will be dropped **less** than 70 despite resuscitation

Question 31

What meds do we use for cardiogenic shock?

Answer 31

Milrinone Dopamine Dobutamine

Question 32

What meds do we use for cardiogenic shock?

Answer 32

Milrinone Dopamine Dobutamine The inotropes

Question 33

PaO2/FiO2 requirements for MODS?

Answer 33

They will need more and more oxygenation.

Question 34

Peep requirements for MODS?

Answer 34

It'll be higher than 7.5 going up to 10-12. peep.

Question 35

What happens to renal/output in MODS?

Answer 35

Urine output will be less than the 0.5ml/kg/hr CR will increase 50% They will need to have that CRRT dialysis

Question 36

What will platelets be like in MODS?

Answer 36

Platelets **below** 100,000 PT/PTT will be upper limit of normal * need to pay attention due to anticoagulation therapy

Question 37

Metabolic labs for MODS

Answer 37

Low ph so below 7.30 High lactate greater than 2

Question 38

Hepatic labs for MODS

Answer 38

Liver enzymes greater than 2x upper limit of normal Jaundice, scelera, anemia

Question 39

CNS assessment of MODS patients

Answer 39

Altered LOC Decrease Glasgow coma scale * 15 is normal , 8 intubate * if you don't know the baseline, find out from family