SIRS And MODS Flashcards
What is SIRS?
Systemic inflammatory response syndrome
Widespread systemic inflammation
What are the hallmarks of SIRS?
Perfusion abnormalities
Disruption of microcirculation
Organ damage
** untreated, leads to MODS
T/F: SIRS is always a secondary condition to an underlying disease process
True
What are the diagnostic criteria for SIRS in the Canine??
Two or more of any of the following:
Temp either LOW(<100.6) or HIGH(102.6)
Heart rate HIGH (>120bpm)
Resp rate HIGH (>20bpm)
WBC either LOW (<6000) or HIGH (>16,000)
What are the diagnostic criteria for SIRS in cats>
Three or more of the following..
Temp LOW (<100) or HIGH (104)
Heart rate LOW (<140) or HIGH (>225)
Resp rate HIGH (>40bpm)
WBC either LOW (<5000) or HIGH (>19000)
You have identified SIRS in your patient.. what steps will you take in this patient??
Identify underlying dz or pathology
Rule out sepsis
Provide hemodynamic support
Identify, track,and support organ dysfunction
Treatment targeted to underlying dz
Common sources of Infectious SIRS?
Septic peritonitis Pyothorax Endocarditis Bacterial fasciitis Parvoviral enteritis
Common sources of non-infectious SIRS?
Pancreatitis Immune mediated dz Heat stroke Trauma Burns
If the patient fits SIRS criteria but you cannot find an underlying disease … what should you do?
KEEP LOOKING if patient is sick
What is the definition of sepsis?
Systemic inflammatory response (SIRS) due to INFECTION
—can be caused by bacteria, fungus, virus, or protozoa
What is the most common type of sepsis?
Gram negative — usually ecoli in the GI system
LPS is bound by LPS binding protein
Activated Toll like receptors and other pro inflammatory things in Tcells => leads to cytokine storm
What is the neurohormonal response induced by SIRS?
Pro-inflammatory molecules induce …
Baroreceptor-mediated catecholamine release
Counterregulatory hormones
- glucagon
- ACTH
- cortisol
T/F: septic patients also have SIRS
True
Sepsis is defined as SIRS + infection
Signs of septic shock in dog?
Hyperdynamic
Hypermetabolic
Tachycardia Tachypnea Hyperemia Decreased CRT Pyrexia
Signs of septic shock in cats?
Lethargic
Bradycardia
Hypothermic
Pale or icterus
Weak pulses
— never seen hyperdynamic phase, go straight to deocompensated state
What clinical signs do you see in early decompensated sepsis?
Failure of compensatory responses
Hypotension and hypoperfusion
Collapse
Decreased mentation
What are the goals of treatment for SIRS>
Hemodynamic optimization
IV fluids (hypovolemia)
Vasopressor therapy (refractory hypotension; distributive shock -> septic shock)
Resuscitation end points
What type of early antibiotic therapy will you do for suspected sepsis patients?
4 quadrant therapy!
Gram pos
Gram neg
Aerobes
Anaerobes
Should you ever delay early antibiotic treatment in sepsis to get a culture?
NO!
Better survival if antibiotics are started right away
What is MODS?
Altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention
In what systems can organ dysfunction be seen in?
Endothelial
Cardiopulmonary
Renal
Hepatic
Nervous
Endocrine
GI
— all associated with progression of uncontrolled systemic inflammation and DIC
T/F: there is an increase in mortality with the number or organ systems affected
True
What is the pathophysiology leading to MODS?
SIRS (infectous or non-infectous) —> microvascular dysfunction causing altered blood flow, hypoxia, ischemia, DIC, and reperfusion injury —> MODS —> mortality
When does SIRS become MODS?
When there is activation and dysregulation of the inflammatory cascade
Endothelial damage exposes tissue factor leading to coagulation derangement
What are the three models of MODS?
1 hit model — result of a massive initial insult (eg trauma or septic peritonitis )
2-hit model — multiple insults: a priming insult followed by second hit —> exaggerated inflammatory response (eg aspiration pneumonia following trauma)
Sustained hit model— continuous insult (eg drug resistant bacterial infection)
What are the mechanisms of organ dysfuntion>
Ischemia and reperfusion injury
Compartment syndrome
Bacterial translocation and endotoxemia
Endothelial cell activation and chemotaxis
Idiosyncratic drug reactions/toxicities
What are risk factors for bacterial translocation across the GI mucosa?
Drugs - ulceration Metabolic disease Hypotension/ischemia Inflammatory disease Infectous disease Toxins Neoplasia Paraneoplasic
—> inflammation in occurring in response.. when you have ischemic gut that is reperfused, the inflammatory mediators are elaborated and distributed through the lymphatic to distant organs
