Patho: SIRS, organ dysfunction & shock Complete Questions And Answers

Systemic Inflammatory Response Syndrome (SIRS) - SNS is activated in an overwhelming inflammatory response to severe trauma to body diagnosing SIRS - Tachycardia Tachypnea Hyper/hypothermia (>38 c or <36 c) Leukocytosis/leukopenia Compensatory Anti-Inflammatory Response Syndrome (CARS) - After SIRS pts are in an immunosuppressed state that can lead to sepsis Sepsis/septicemia - Infection of blood that can overwhelm immune system and lead to MODS Severe sepsis criteria - Altered mental status Hypoxemia Hypotension Renal insufficiency DIC Increased plasma lactate level Liguria (<30ml/hr) Diseminated Intravascular Coagulation (DIC) - Failure of coagulation system Warm shock - Pt is warm to touch and has pink skin despite shock onset Onset of MODS - Vasodilation, inflammation, and microthrombi can lead to tissue hypo-perfusion with ischemiaMulti-Organ Dysfunction Syndrome (MODS) - Progressive and potentially reversible dysfunction of two or more organs or systems commonly induced by sepsis and leading cause of death in ICU Serum Lactate acid levels - >2 is sepsis >4 is septic shock Lactate and procalcitonin are very specific to sepsis cardiogenic shock - Caused by inadequate function of the heart: *MI, arrhythmias, tamponade (fluid buildup around heart restricting its action) Key signs of cardiac tamponade - Distant heart sounds Low BP High jugular venous pressure (pulsus paradoxus) hypovolemic shock - shock resulting from blood or fluid loss: severe dehydration, diarrhea, vomiting, ascites or severe burns Decrease in venous return anaphylactic shock - Allergy causes bronchospasms, angioedema, or urticaria neurogenic shock - Spinal cord/ brain injury (SNS disruption) Anesthesia Parasympathetic takes over causing bradycardia Manifestations of sepsis - Hypoxemia Altered mental state Elevated plasma lactate level OliguriaBeck's triad - hypotension, JVD, muffled heart sounds Hormone release during shock - Epinephrine and cortisol Inhibit insulin activity Increased glucose levels Decreased WBC activity with hyperglycemia treatment meds for cardiogenic shock - Sometimes beta blockers Aspirin Dopamine Dobutamine Treatment of hypovolemic shock - fluid replacement Volume expanders Maybe a blood transfusion Treatment of anaphylactic shock - epinephrine, antihistamines, glucocorticoids IV fluids treatment of neurogenic shock - IV vasoconstrictors Angiotensin II IV fluids Sometimes atropine