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Surgery M4 part 1 > SIRS & Shock > Flashcards

SIRS & Shock Flashcards

1
Q

What are the the stimuli’s that could cause SIRS?

A

INFECTION

  • severe bacterial infection
  • viral infection
  • fungal infection
  • toxemia

NON-INFECTIOUS

  • burns
  • major trauma
  • acute pancreatitis
  • disseminated malignancy
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2
Q

What will the stimulus cause?

A

extensive tissue damage

leading to massive release of cytokines (IL-1 & TNF-a)

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3
Q

What is the pathogenesis or SIRS?

A

Stimulus -> extensive tissue damage -> massive release of cytokines (IL-1, IL-2 & TNF-a) -> body reaction

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4
Q

What are the body reactions that occur?

A

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

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5
Q

What is the diagnostic criteria of SIRS?

A
  • temp >38 or <36
  • RR >20
  • HR >90
  • WBCs >12000 or <4000

2 are enough to make diagnosis

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6
Q

What is the function of IL-10?

A

suppressor to balance inflammatory reaction released during Compensatory anti-inflammatory Response Syndrome (CARS)

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7
Q

What is the difference between SIRS & sepsis?

A

sepsis = INFECTIOUS SIRS

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8
Q

What are the complications of SIRS?

A 
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)
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9
Q

What treatment should be done in case of SIRS?

A
  • respiratory support (O2 mask)
  • cardiac support
  • circulatory support
  • primary source control
  • STEROIDS
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10
Q

What is shock?

A

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)

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11
Q

What is the cause of circulatory shock?

A

reduced cardiac output

  • hypovolemia
  • cardiogenic
  • obstructive
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12
Q

What are the types of redistributive shocks?

A

increased cardiac output

  • neurogenic
  • anaphylactic
  • septic
  • endocrinal
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13
Q

What is the pathophysiology of redistributive shock?

A
  • vasodilation
  • decreased vascular resistance
  • hypotension
  • altered microvascular perfusion
  • altered cellular oxygen metabolism
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14
Q

What is the cause of septic shock?

A

persistent tissue hypoperfusion caused by severe sepsis

- bacterial endotoxins (gram -ve) & release of cytokines

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15
Q

What is the cause of anaphylactic shock?

A

allergic mediators

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16
Q

What is the cause of neurogenic shock?

A

severe pain -> intense vagal stimulation

17
Q

What are the predisposing factors for septic shock?

A 
VIRULENT FACTORS 
PATIENT FACTORS 
- immunocompromised 
- prolonged use of corticosteroids 
- malignancy 
- malnutrition 
- previous disease
18
Q

What is the evolution of SIRS to Septic shock?

A

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

19
Q

What are the stages of septic shock?

A

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
20
Q

How should septic shock be managed?

A

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

21
Q

How should a patient presenting with septic shock be resuscitated?

A

Circulatory support

  • Ringer’s Lactate (Crystalloids)
  • Vasopressors & inotropes

Respiratory support
- ventilate if PO2 = 60mmHg

Renal support

Correct coagulopathy
- fresh frozen plasma

22
Q

What should be monitored after resuscitation of patient?

A

Vital signs
CVP = 5cm
urinary output = 1mL/kg/hr

23
Q

How should infection be eradicated?

A 
ANTIBIOTICS 
SURGICAL INTERVENTION
- abdominal exploration in peritonitis 
- drainage of abscess 
- debridement of necrotic tissue

Surgery M4 part 1 (47 decks)

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