SIRS Flashcards
Inflammation:
Protective response (Repair process) intended to eliminate the initial cause of cell injury, removed the damaged tissue, and generate new tissue.
Vascular Phase:
(The vase is opposite)
Characterized by changes in small blood vessels
(Arterioles and Venules) at the site of Injury.
It Begins with momentary Vasoconstriction.
Followed Rapidly by Vasodilation. This leads to increased capillary blood flow and heat and redness. Also vascular permability, edema, and swelling, pain and impaired function.
Cellular Phase: (cells are neutrol)
Delivery of Leukocytes (Neutrophils) to Injury site for host Defense.
Cellular Phase: - 3 steps (cellular marg in diapers with chemo)
Margination
Diapedesis
Chemotaxis
Coagulation:
Prevent Blood Loss and Hemorrhage.
Systemic Inflammation
Occurs when local injury results in systemic manifestation as inflammatory mediators released into the circulation.
Systemic Inflammation - Most prominent Manifestations are: (think infection - 4 things) (Sir, your inflammation is a FLWP)
Alteration in WBCs
Fever
Alteration In Plasma Protein ( High CRP & ESR)
Lymphadenitis.
when the body can’t keep up with the response to inflammation…
Uncontrolled inflammatory Response with production and release of large quantities of inflammatory mediators. This is SIRS. this can lead to MODS.
MODS: definition
(2 mods failing)
Continuation of SIRS.
Usually is a progressive failure of two or more separate organ systems as the organ is not able to maintain hemeostasis.
SIRS - Pathophysiology (inflammation, mediators, systemic/destruction, SIRS/endothelial)
Following the Trigger or insult, local Inflammatory Process (Vascular, Cellular, Coagulation Process) and Inflammatory mediators are released into the local area.
Small quantities of local mediators are released into circulation to improve the local response. This is controlled by release of Endogenous antagonist (IL -1 ra). The goal is homeostasis.
If homeostasis is not restored, a significant systemic reaction occurs. The mediator release leads to destruction rather than protection. A consequence of this is the activation of numerous uncontrolled cascades and subsequent loss of circulatory integrity (SIRS).
SIRS cause organ’s endothelial Damage and microvascular Thrombosis due to Coagulation Cascade. This leads to Multiorgan Dysfunction and Failure. (MODS).
Diagnostic Criteria of SIRS - 2 or more - 4 total
(Sir, you vitals are diagnostically bad)
If Two or more of the following Manifestations:
Altered Temperature of [ >38°C (100 F)or < 36°C (96.8 F)].
Heart rate of [> 90 bpm]
Respiratory rate of [ >20 breaths per minute or a PaCO2 level of < 32 mm Hg].
Abnormal white blood cell count [>12,000/µL or <4,000/µL or >10% bands].
Clinical manifestation of SIRS/MODS - appearance and behavior
(sir, you are confused, puffy, and ill)
General Appearance:
Hospitalized patient in critical care units.
Appears critically ill
Confused/ Unconscious.
Anasarca (Generalized body Edema)
Clinical manifestation of SIRS/MODS- Respiratory Manifestation - and what is the most sensitive marker???
And what causes SIRS?
(Sir, the most important is that you are tachy)
(alden is not a sir)
Hypoxic
Tachypnea (RR is most sensitive marker of the severity of illness.)
ARDS (Capillary leakage into alveoli)
Clinical manifestation of SIRS/MODS - high or low bp?
(sir, your BP is low)
Cardiac Manifestations:
Increase in HR (Not detected with beta-blockers).
Hypotension (Establishment of intravenous access and fluid resuscitation/Inotropic support).
Heart Failure.
Clinical manifestation of SIRS/MODS - Gastrointestinal Manifestations - bowels?
(Sir, your bowels aren’t moving)
Ischemic Bowel (Bacterial translocation into circulation—— Sepsis)
Clinical manifestation of SIRS/MODS - Renal Impairment: not necrosis
(Sir, you are ana)
Anuria (hemodialysis)
Acute Renal Failure.
Clinical manifestation of SIRS/MODS - Metabolic changes: - acidosis?
(Sir, you are acidic)
Prolonged Hypermetabolic state.
Metabolic Acidosis.
High lactate level
Anaerobic metabolism (breakdown of fats and proteins)
Clinical manifestation of SIRS/MODS - Neurologic changes: - what is the GCS?
(Sir, glasgow is at 6)
Confusion
Disorientation
Agitation
CNS Failure: GCS < 6 / Coma