T10: SIRS & MODS Flashcards
SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS)
systemic inflammatory response to a variety of insults; generalized inflammation in organs
what can result in SIRS
Infection (sepsis), ischemia, infarction and injury (burns, crush injury, CPR) can result in SIRS
labs for liver
glucose and blood clotting, AST ALT
labs for kidney
BUN, CRE, GFR, electrolytes, UA
labs for heart
troponin, BNP, EKG, Echo
labs for lung
ABG, chest x-ray
labs for brain
CBC (problem with the pituitary), brain CT, glucose and sodium
MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS):
failure of two or more organ systems (results from SIRS)
RELATIONSHIP OF SHOCK, SIRS AND MODS
SIRS –> Shock states –> MODS
SIRS and MODs can cause DIC because
the bone marrow is a system
o Clots form and bleeding at the same time; eventually the body will be depleted of platelets and the patient will continue to bleed
the respiratory system is often the first system to
show signs of dysfunction in SIRS and MODS
SIRS and MODS: respiratory
o Alveolar edema, decrease in surfactant, increase in shunt, V/Q mismatch
- End result: ARDS (vent setting with PEEP)
SIRS and MODS: CV
Myocardial depression and massive vasodilation, results in decreased SVR and BP which increases HR to compensate, albumin and fluid move out of blood vessels
SIRS and MODS: neuro
o Mental status changes (confused, agitated, combative, disoriented, lethargic or comatose) due to hypoxemia, inflammatory mediators, or impaired perfusion
o Often early sign of MODS
SIRS and MODS: renal
Hypoperfusion of the kidneys activates the renin-angiotensin-aldosterone system resulting in systemic vasoconstriction
o Nephrotoxic drugs, especially antibiotics (monitor drug levels)
SIRS and MODS: GI
o Motility decreased: abdominal distention and paralytic ileus
o Decreased perfusion: risk for ulceration and GI bleeding
o Potential for bacterial translocation
SIRS and MODS: hypermetabolic state
o Hyperglycemia-hypoglycemia
o Insulin resistance-Catabolic state
o Liver dysfunction
o Lactic acidosis
lactic acid > than…
> 4 something is wrong also look at pH for LACTIC ACIDODS LOOK AT LIVER (liver cannot clear out toxins)
SIRS and MODS: Prevention and treatment of infection
o ANTIBIOTICS
- Send appropriate cultures and start broad-spectrum antibiotic therapy, as ordered. Adjust therapy based on the culture results, if needed.
- Strict asepsis for invasive lines (urinary catheters, IVs, ET tubes, arterial lines)
SIRS and MODS: Maintenance of tissue oxygenation
may need to be intubated or on a ventilator
- Decrease O2 demand and increase O2 delivery
· MORPHINE! A vasodilator so that the coronary artery gets more O2
· We can also decrease O2 demand by bed rest, cluster care, maintaining body temperature, sedation, and reducing stimuli
support for DIC
appropriate blood products (look at CBC differential to determine what blood products are needed)
support for ARDS
aggressive O2 therapy and mechanical ventilation
support for renal failure
continuous renal replacement therapy
