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