SIRS & Shock Flashcards
What are the the stimuli’s that could cause SIRS?
INFECTION
- severe bacterial infection
- viral infection
- fungal infection
- toxemia
NON-INFECTIOUS
- burns
- major trauma
- acute pancreatitis
- disseminated malignancy
What will the stimulus cause?
extensive tissue damage
leading to massive release of cytokines (IL-1 & TNF-a)
What is the pathogenesis or SIRS?
Stimulus -> extensive tissue damage -> massive release of cytokines (IL-1, IL-2 & TNF-a) -> body reaction
What are the body reactions that occur?
IMMUNOLOGICAL
- massive release of inflammatory mediators -> vasodilation
ENDOCRINAL
- catecholamines
- vassopressor
- RAA axis
- cortisone
HEMATOLOGICAL
- increase coagulation cascade
- decrease natural anti coagulants & thrombolytic system
- direct endothelial damage
NEUROLOGICAL
- strong sympathetic stimulation
What is the diagnostic criteria of SIRS?
- temp >38 or <36
- RR >20
- HR >90
- WBCs >12000 or <4000
2 are enough to make diagnosis
What is the function of IL-10?
suppressor to balance inflammatory reaction released during Compensatory anti-inflammatory Response Syndrome (CARS)
What is the difference between SIRS & sepsis?
sepsis = INFECTIOUS SIRS
What are the complications of SIRS?
brain -> encephelopathy endocrine -> hyperglycemia heart -> tachyarrythmias (hyper sympathetic & catecholamines) & precipitated myocardial ischemia lung -> adult respiratory distress syndrome (ARDS) kidney -> acute tubular necrosis (ATN) GIT -> bacterial translocation blood -> DIC MODS (multi-organ dysfunction syndrome)
What treatment should be done in case of SIRS?
- respiratory support (O2 mask)
- cardiac support
- circulatory support
- primary source control
- STEROIDS
What is shock?
failure of circulatory system to maintain adequate perfusion to vital organs, leading to impaired cellular metabolism –> cellular hypoxia (normal relationship between oxygen demand & oxygen supply is impaired)
What is the cause of circulatory shock?
reduced cardiac output
- hypovolemia
- cardiogenic
- obstructive
What are the types of redistributive shocks?
increased cardiac output
- neurogenic
- anaphylactic
- septic
- endocrinal
What is the pathophysiology of redistributive shock?
- vasodilation
- decreased vascular resistance
- hypotension
- altered microvascular perfusion
- altered cellular oxygen metabolism
What is the cause of septic shock?
persistent tissue hypoperfusion caused by severe sepsis
- bacterial endotoxins (gram -ve) & release of cytokines
What is the cause of anaphylactic shock?
allergic mediators
What is the cause of neurogenic shock?
severe pain -> intense vagal stimulation
What are the predisposing factors for septic shock?
VIRULENT FACTORS PATIENT FACTORS - immunocompromised - prolonged use of corticosteroids - malignancy - malnutrition - previous disease
What is the evolution of SIRS to Septic shock?
SIRS -> SEPSIS -> SEVERE SEPSIS -> SEPTIC SHOCK
>38C or <36C SIRS Sepsis severe sepsis
RR >20 + + +
HR > 90 infection organ damage persistent hypotension
WBC >12000 or <4000 & hypotension
What are the stages of septic shock?
EARLY LATE
- hyperdynamic (hot) - hypodynamic (cold)
- reversible - irreversible
- inflammatory response present - pyrogenic response lost
- hypotension & tachycardia & tachypnea - bounding pulse - rapid weak pulse
- fever - hypothermia
- warm flushed skin (vasodilation) - cold pale skin (vasoconstriction)
- +- MOF - MOF
How should septic shock be managed?
1- ADMISSION TO ICU (first line) as early as possible
2- resuscitation & monitoring
3- eradicate infection (massive parenteral empirical broad spectrum till C&S result)
4- continuous monitoring
5- corticosteroids
How should a patient presenting with septic shock be resuscitated?
Circulatory support
- Ringer’s Lactate (Crystalloids)
- Vasopressors & inotropes
Respiratory support
- ventilate if PO2 = 60mmHg
Renal support
Correct coagulopathy
- fresh frozen plasma
What should be monitored after resuscitation of patient?
Vital signs
CVP = 5cm
urinary output = 1mL/kg/hr
How should infection be eradicated?
ANTIBIOTICS SURGICAL INTERVENTION - abdominal exploration in peritonitis - drainage of abscess - debridement of necrotic tissue
