Sepsis, shock & MODS PDF
Preview Sepsis, shock & MODS
Sepsis, shock & MODS Monika Grochova, MD, PhD. Jozef Firment, MD, PhD. Department of Anaesthesiology & Intensive Care Medicine, Medical faculty UPJŠ Košice DEFINITION OF SHOCK • Complex syndrom developped by insufficient capillary nutritional perfusion of tissues, insuficint delivery of oxygen to the mitochondria • Consequences: deficiency of oxygen & energetical resources in tissues = pathological metabolism (anaerobic) & cummulation of toxic tn e m r products. iF 2 SHOCK ACCORDING TO PATOPHYSIOLOGY • Hypovolemic – (dehydration, haemorrhage) • Distributive – (spine laesion, high-level spinal anaesthesia, anaphylactic, septic) • Obstructive – (pulmonary embolism, hydropericard, pneumothorax) • Cardiogenic tn e m r iF – (AMI) 3 SHOCK ACCORDING TO CLINICAL REASONS • anaphylactic shock ( alergy to medicaments, to venom, food, fruits ) • neurogenic shock spinal shock (spinal cord laesion, high spinal anaesthesia...) • haemorrhagic shock • traumatic shock • burn shock • toxic shock (pancreatitis...) • septic shock (sepsis...) tn e m r iF • cardiogenic shock (AMI...) 4 DIFERENTIAL DG Reason: Saqual: Anaphylactic response to allergen • anafylactic Loos of 20% circul. blood volume • haemorrhagic Traumat. laesion of cervical spine • neurogenic Polytrauma • traumatic • burn Burns (>20%, >10% children, >5% newborns and babies) • toxic Acute h.-necrot. pancreatitis • septic G- focus with bacteriaemia tn e m • cardiogenic r iF Large diaphragmatic MI 5 PREHOSPITAL PHASE – FIRST SIGNS Circulatory parameters: • BP, P, circulatory centralisation, slow capillary return, SpO , cold sweat vs hot 2 red skin • restlessness-lethargy, shivering... tn e m r iF 6 O supply 2 tn e m r iF 7 The oxygen delivery cascade indicating the potential role of current and future therapies to optimize oxygen delivery to the tissues tn e m r iF Rampal T, Jhanji S, Pearse R: Using oxygen delivery targets to optimize resuscitation in critically ill patients. Current Opinion in Critical Care 2010, 16:244–249 8 s HYPOTENSION n g i s k c o h S pulse rate Shock index = systolic BP Interpretation: belove 0,5 = normal find out above 1,0 = treatment is needed Cave! Digitalis, beta-blockers, cardiostimulators... tn e m r iF 10 OLIGURIA s n g i s k Diuresis < 0,5 ml/kg/hour c o h S LABORATORY SIGNS MLAC > 2,5 mmol/l tn SvO2 > 70% or < 70% e m r iF 11
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