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
Management of SIRS/MODS - first step
Initial Medical Care:
History
Physical Examination
Laboratory testing
Imaging Studies
Management of SIRS/MODS - second step - just treatment
Treatment should be focused and based on possible inciting causes of SIRS ( MI vs. Pneumonia)
Management of SIRS/MODS - third step
(Sir, 3rd is your lungs)
Supplemental Oxygen
Pt may need Ventilator Support to maximize oxygen delivery. Patients who do not respond to increased oxygen supply have a poor prognosis.
Management of SIRS/MODS - 4th step
(Sir, this your 4th drink)
Hypotensive should receive intravenous fluids, and, if still hypotensive after adequate resuscitation, Inotropes agents should be administered.
Management of SIRS/MODS - 4th step meds
Medications:
TNF-and IL-1 receptor antagonists
Antibradykinin
Platelet-activating factor receptor antagonists
Anticoagulants
Low-Dose Steroids.
Studied showed no statistically significant benefits in treatment of SIRS.
Management of SIRS/MODS – 4th step meds
Medications:
Antibiotics
Studied showed no statistically significant benefits in treatment of SIRS.
Indicated in sepsis or septic shock.
Management of SIRS/MODS - step 5
Consultation
Vary on cause of SIRS (Cardiology for MI)
Surgical (Abscess drainage, prosthetic devices)
Intensivists (MODS).
Infectious Disease Expert (HIV, Organ Transplantation, no response to antibiotics).
Generally collaborative care and multidisciplinary team is needed.
Management of SIRS/MODS - step 6
Diet
Enteral feedings.
Feeding Tube below the level of pylorus to prevent aspiration.
Management of SIRS/MODS - step 7 - activity
Activity
Usually Pts are confined to bed.
Stress Ulcer and DVT prophylaxis.
inflammation triggers are
(Sir, I I I am inflammed)
infection, injury, and ischemia
the inflammatory phases are - YOU KNOW THIS
vascular phase, cellular phase, and coagulation
inflammatory mediators - plasma derive mediators
(Sir, your plasma tv needs a compliment from brady and clot)
compliment system, bradykinin, clotting factors
inflammatory mediators - cell derived mediators
(Sir, the mediator is in a cell with prosty and sera)
histamine, serotonin, prostaglandins,
if lungs sound bad,
make sure pt is using incentive spirometer
SIRS/MODS = Hematologic manifestations
(Sir, you are a DIC)
Hematologic:
Hypercoagulopathy
DIC
SIRS/MODS = liver abnormalities- and jaundice?
(Sir, you are late and jaundice)
Liver Abnormalities:
Hyperbilirubinemia.
Liver Enzymes > 2 × normal
Jaundice (this is a late sign)
High lactate level numbers
(no milk after 2 yrs old)
anything over 2 should be investigated
SIRS - ultimate treatment for pt
control the source
how quickly to treat patient?
in less than an hour
is there a specific drug for SIRS and MODS?
no, you have to control the source
criteria for SIRS - 2 or more (RR and WBC)
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].
Local Inflammation - what symptoms - local is hot
- Local Inflammation
Heat Swelling Redness
Pain Impaired Function - Systemic Inflammation.
SIRS/MODS - how is the abdomen?
(Sir, your abdomen is distended)
Abdominal distension.
Paralytic Ileus.
SIRS/MODS - bowel sounds?
(Sir, I can’t hear your bowels)
Decreased/ diminished Bowel Sounds.
SIRS/MODS - BM?
GI bleeding
Diarrhea.
SIRS/MODS - albumin and protein levels?
Serum albumin and protein levels are low.
inflammatory mediators
(Luke and nitro are free and inflammed)
leukotrienes, nitric oxide, o2 free radicals, cytokines.
vital signs with SIRS - change quickly or slowly?
These should be acute alteration from baseline data in the absence of other known causes of abnormalities.
most common cause of SIRS? AND most common cause SIRS leads to MODS?
sepsis
