CC Exam 3 MODS & DIC
Treatment measures to reverse MODS are aimed at
(1) controlling the initiating event, (2) promoting adequate organ perfusion, (3) providing nutritional support, (4) maximizing patient comfort
retroperitoneal bleeding
-abdomen firm and tender to palpation -distended ↑ abdominal girth
micro frank bleeding neurologic
-anxiety -restlessness -↓mentation -altered LOC, consciousness -headache -visual disturbances -conjunctival hemorrhage
DIC mortality
-can exceed 80% in severe w/ischemic thrombosis, frank hemorrhage, and MODS -primary prognostic factor is ability to treat underlying condition
DIC hemorrhage
-depleted coagulation factors and platelets may be replaced to reestablish potential for normal hemostasis -fresh frozen plasma
kidneys - how are they affected in MODS?
-first organ in cardiogenic shock to show s/s of dysfxn
How are Lungs affected in MODS?
-first organs to show s/s of dysfxn -progessive dyspnea -respiratory failure -ALI or ARDS -requires intubation and mechanical ventilation
micro thrombosis GI
-gastric pain -heart burn
micro frank bleeding GI
-hematemesis -melena; tarry stools -bright red blood form rectum -retroperitoneal bleeding
micro frank bleeding renal
-hematuria
micro frank bleeding respiratory
-high pitched bronchial breath sounds -tachypnea -↑consolidation -s/s of ARDS
MODS s/s
-hypermetabolic state -hyperglycemia -hyperlactic acidemia -↑ BUN -worsening immunocompromise -↑ risk of bleeding -hematologic system dysfxnal -CV system unresponsive to vasoactive agents -neuro response progresses to unresponsiveness or coma
micro thrombosis respiratory
-hypoxia secondary to clots in lung -dyspnea -chest pain w/deep inspiration -↓breath sounds over areas of large embolism
heparin
-in DIC = controversial -interrupt thrombosis process -in absence of bleeding, recommended to prevent VTE -observe for normalization of plasma fibrinogen concentration and diminishing s/s of bleeding -fibrinolytic inhibitor (aminocaproic acid) may be used
DIC treatment
-most important: FIND underlying cause -improve oxygenation -replacing fluids -correcting F/E imbalances -admin vasopressors
micro frank bleeding skin
-petechiae; periorbital, oral mucosa -bleeding gums -oozing from wounds, previous injection sites, around catheters -epistaxis -diffuse ecchymoses -subcutaneous hemorrhage -joint pain
MODS characteristics
-primarily assoc. w/septic shock -progression of shock state -altered fxn in 2+ organs -high mortality at 65% -frequently occurs toward end of continuum when perfusion can't be effectively restored -organ tissues hypoperfused at micro and macrocellular level -organ dysfxn requiring mechanical and pharmacologic interventions
micro frank bleeding circulatory
-tachycardia
MODS treatment
-↑ amount of IV fluids and vasoactive agents for BP and CO
micro thrombosis neurologic
-↓ alertness and orientation -↓pupillary rxn -↓response to commands -↓ str and movement ability
DIC labs
-↓ platelet count -↑ extrinsic pathway -↑intrinsic pathway -↑clot formation -↓amount available for coagulation -↑local fibrinolysis -↑fibrinolysis -fibrinolytic activity ≤ 1 hr
micro thrombosis circulatory
-↓ pulses -capillary filling time >3 seconds
micro thrombosis skin
-↓ temp & sensation -↑pain -cyanosis in extremities, nose, earlobes -focal ischemia -superficial gangrene
micro thrombosis renal
-↓ urine output -↑ creatinine -↑ BUN
MODS definition
Multiple Organ Dysfunction Syndrome
The diagnosis of DIC is often established by laboratory tests that reflect what:
consumption of platelets and clotting factors: drop in platelet count, elevation in fibrin degradation products and D-dimer, increase in PT and aPTT, low fibrinogen level
cryoprecipitate is given why?
give to replace fibrinogen and factors V and VII
DIC patho
natural anticoagulant pathways within the body are simultaneously impaired fibrinolytic system is suppressed so that a massive amount of tiny clots forms in the microcirculation as the platelets and clotting factors form microthrombi, coagulation fails paradoxical result of excessive clotting is bleeding
DIC is not a disease but a
sign of an underlying condition
DIC definition
Disseminated Intravascular Coagulation
