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Lernmaterialien für Critical Care an der University of Pretoria

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Results

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  • Systemic vasodilation ☞ distributive shock
  • Organ dysfunction
  • Drop in BP
  • Initiation of clotting system
  • MOD ☞ MOF ☞ Death
Lösung ausblenden
TESTE DEIN WISSEN

Treatment

Lösung anzeigen
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  • Monitoring of trends is VITAL
  • Close monitoring of patients @ risk of developing SIRS
    • any changes in trends are rapidly observed and dealt with
  • Monitor:
    • Temperature
    • Pulse
    • Respiration
Lösung ausblenden
TESTE DEIN WISSEN

Complications of SIRS: Respiratory dysfunction

Lösung anzeigen
TESTE DEIN WISSEN
  • Lungs commonly affected (primary/secondary)
  • ARDS (acute respiratory distress syndrome) characterised by:
    • ↑ pulmonary vascular permeability ☞ leaking of protein rich fluid into interstitium and alveoli ☞ ↓ gas exchange and ventilation-perfusion mismatch
  • Proliferative stage: fibroblasts form fibrous tissue in alveoli
  • Fibrotic stage: collagen deposition in alveolar, vascular and interstitial beds (overlaps with proliferative stage)
  • Diagnosis, presence of inciting causes:
    • bilateral alveolar infiltrates on rads
    • ↓ pulmonary compliance
    • absence of LHF
    • presence of hypoxaemia
  • Treatment: 
    • oxygen supplementation and mechanical ventilation
Lösung ausblenden
TESTE DEIN WISSEN

Complications of SIRS: Cardiovascular dysfunction


Lösung anzeigen
TESTE DEIN WISSEN
  • Compromised cardiovascular signs:
    • ↓ CO
    • presence of hypotension
    • possible arrhythmias
  • Unknown patho-mechanism
    • possibly a results of cytokine mediated cardiac damage
    • hypoxemia, acid-base disturbances, hypovolemia and pain are also possibly playing a role 
  • Treatment:
    • vasopressors
    • inotropes (norepinephrine, dobutamine and dopamine)
Lösung ausblenden
TESTE DEIN WISSEN

Complications of SIRS: Renal dysfunction


Lösung anzeigen
TESTE DEIN WISSEN
  • Acute renal failure which is a common component of MODS
  • Underlying pathology: acute tubular necrosis
  • Characterised by:
    • anuria/oliguria
    • azotaemia
  • Treatment:
    • aggressive fluid therapy 
    • diuretics (mannitol or furosemide)
    • inotropes (dopamine)
    • aminophylline
Lösung ausblenden
TESTE DEIN WISSEN

Complications of SIRS: GIT dysfunction


Lösung anzeigen
TESTE DEIN WISSEN
  • In dogs GIT is very sensitive to ischaemia
    • IN MODS - GIT is often compromised
  • Characterised:
    • ileus (lack of movement of the intestine)
    • vomiting
    • diarrhoea
    • GIT ulceration
    • GIT barrier breakdown and bacterial translocation
    • inability of tolerate enteral feeding
  • Treatment:
    • anti-emetics
    • prokinetics
    • gastric protectant 
    • early enteral nutrition
    • maintain fluid and electrolyte balance
Lösung ausblenden
TESTE DEIN WISSEN

Complications of SIRS: Haematological dysfunction

Lösung anzeigen
TESTE DEIN WISSEN
  • Evidence of DIC (Disseminated intravascular coagulation) especially in critically ill patients
  • Diagnosis of DIC: (presence of underlying critical illness + 3 of the below abnormalities)
    • thrombocytopaenia
    • ↑ PT (prothrombine time) + PTT (partial thromboplastin time)
    • ↓ fibrinogen + antithrombin
    • ↑ fibrin degradation products or D-dimers
  • Anaemia, leukocytosis or leukopaenia ARE NOT MARKERS OF MODS
    • Their presence complicate the condition
  • Patho-mechanism: 
    • SIR ☞ endothelial damage, cytokines released ☞ perfect procoagulant environment 
    • widespread coagulation occurs ☞ consumption of available clotting factors and platelets ☞ consumption coagulopathy with haemorrhage 
    • Hepatic dysfunction worsen the coagulopathy
    • Anaemia due to haemorrhage + microvascular haemolysis + thrombosis ☞ worsen ischaemia ☞ MODS
  • Treatment:
    • blood transfusion
    • plasma transfusions
    • oxygen therapy
    • vitamin K1 and heparin or other anticoagulants
Lösung ausblenden
TESTE DEIN WISSEN

Complications of SIRS: Liver dysfunction

Lösung anzeigen
TESTE DEIN WISSEN
  • Due to ischaemic damage
  • Signs:
    • hypoglycaemia
    • hypoalbunaemia
    • coagulopathy
    • icterus
    • ↑ in biochemical markers of liver damage and dysfunction (alanine, aminotransferase, alkaline phosphatase, ammonia and serum bile acids)
Lösung ausblenden
TESTE DEIN WISSEN

Complications of SIRS: Neurologic dysfunction


Lösung anzeigen
TESTE DEIN WISSEN
  • Due to (poorly understood):
    • hypotension
    • hypoxia
    • hypovolemia
    • microthrombosis
    • metabolic derangements such as hepatic encephalopathy 
  • Signs:
    • weakness
    • altered mentation
    • loss of consciousness
    • confusion
    • coma
    • seizures
Lösung ausblenden
TESTE DEIN WISSEN

SIRS prognosis

Lösung anzeigen
TESTE DEIN WISSEN
  • Very guarded to poor
  • ↑ # of organs failure ☞ worsen prognosis
  • Patients with pre-existing organ compromise 
    • ↑ risk of developing MODS as a result of critical illness
  • Mortality:
    • 20% if reach one organ
    • approximately 100% if reach 4 organ systems
Lösung ausblenden
TESTE DEIN WISSEN

Venom types

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  1. Cytotoxic
  2. Neurotoxic
  3. Coagulopathic/haemotoxic
Lösung ausblenden
TESTE DEIN WISSEN

SIRS

Lösung anzeigen
TESTE DEIN WISSEN

Systemic inflammatory response syndrome

  • Systemic response to a variety of insults
    • NOT ONLY microbiological infections
    • Infectious or non-infectious insult to the body
  • Affects any patients of any age or fitness level
  • Early recognition of SIRS ☞ important to maximise a + outcome and prevent progression
    • difficult to recognise
    • clinical signs differs between species and individuals
    • Cats are challenging to diagnose
  • SIRS progression:
    • SIRS ☞ shock ☞ MODS ☞ MOF
Lösung ausblenden
  • 45721 Karteikarten
  • 4239 Studierende
  • 35 Lernmaterialien

Beispielhafte Karteikarten für deinen Critical Care Kurs an der University of Pretoria - von Kommilitonen auf StudySmarter erstellt!

Q:

Results

A:
  • Systemic vasodilation ☞ distributive shock
  • Organ dysfunction
  • Drop in BP
  • Initiation of clotting system
  • MOD ☞ MOF ☞ Death
Q:

Treatment

A:
  • Monitoring of trends is VITAL
  • Close monitoring of patients @ risk of developing SIRS
    • any changes in trends are rapidly observed and dealt with
  • Monitor:
    • Temperature
    • Pulse
    • Respiration
Q:

Complications of SIRS: Respiratory dysfunction

A:
  • Lungs commonly affected (primary/secondary)
  • ARDS (acute respiratory distress syndrome) characterised by:
    • ↑ pulmonary vascular permeability ☞ leaking of protein rich fluid into interstitium and alveoli ☞ ↓ gas exchange and ventilation-perfusion mismatch
  • Proliferative stage: fibroblasts form fibrous tissue in alveoli
  • Fibrotic stage: collagen deposition in alveolar, vascular and interstitial beds (overlaps with proliferative stage)
  • Diagnosis, presence of inciting causes:
    • bilateral alveolar infiltrates on rads
    • ↓ pulmonary compliance
    • absence of LHF
    • presence of hypoxaemia
  • Treatment: 
    • oxygen supplementation and mechanical ventilation
Q:

Complications of SIRS: Cardiovascular dysfunction


A:
  • Compromised cardiovascular signs:
    • ↓ CO
    • presence of hypotension
    • possible arrhythmias
  • Unknown patho-mechanism
    • possibly a results of cytokine mediated cardiac damage
    • hypoxemia, acid-base disturbances, hypovolemia and pain are also possibly playing a role 
  • Treatment:
    • vasopressors
    • inotropes (norepinephrine, dobutamine and dopamine)
Q:

Complications of SIRS: Renal dysfunction


A:
  • Acute renal failure which is a common component of MODS
  • Underlying pathology: acute tubular necrosis
  • Characterised by:
    • anuria/oliguria
    • azotaemia
  • Treatment:
    • aggressive fluid therapy 
    • diuretics (mannitol or furosemide)
    • inotropes (dopamine)
    • aminophylline
Mehr Karteikarten anzeigen
Q:

Complications of SIRS: GIT dysfunction


A:
  • In dogs GIT is very sensitive to ischaemia
    • IN MODS - GIT is often compromised
  • Characterised:
    • ileus (lack of movement of the intestine)
    • vomiting
    • diarrhoea
    • GIT ulceration
    • GIT barrier breakdown and bacterial translocation
    • inability of tolerate enteral feeding
  • Treatment:
    • anti-emetics
    • prokinetics
    • gastric protectant 
    • early enteral nutrition
    • maintain fluid and electrolyte balance
Q:

Complications of SIRS: Haematological dysfunction

A:
  • Evidence of DIC (Disseminated intravascular coagulation) especially in critically ill patients
  • Diagnosis of DIC: (presence of underlying critical illness + 3 of the below abnormalities)
    • thrombocytopaenia
    • ↑ PT (prothrombine time) + PTT (partial thromboplastin time)
    • ↓ fibrinogen + antithrombin
    • ↑ fibrin degradation products or D-dimers
  • Anaemia, leukocytosis or leukopaenia ARE NOT MARKERS OF MODS
    • Their presence complicate the condition
  • Patho-mechanism: 
    • SIR ☞ endothelial damage, cytokines released ☞ perfect procoagulant environment 
    • widespread coagulation occurs ☞ consumption of available clotting factors and platelets ☞ consumption coagulopathy with haemorrhage 
    • Hepatic dysfunction worsen the coagulopathy
    • Anaemia due to haemorrhage + microvascular haemolysis + thrombosis ☞ worsen ischaemia ☞ MODS
  • Treatment:
    • blood transfusion
    • plasma transfusions
    • oxygen therapy
    • vitamin K1 and heparin or other anticoagulants
Q:

Complications of SIRS: Liver dysfunction

A:
  • Due to ischaemic damage
  • Signs:
    • hypoglycaemia
    • hypoalbunaemia
    • coagulopathy
    • icterus
    • ↑ in biochemical markers of liver damage and dysfunction (alanine, aminotransferase, alkaline phosphatase, ammonia and serum bile acids)
Q:

Complications of SIRS: Neurologic dysfunction


A:
  • Due to (poorly understood):
    • hypotension
    • hypoxia
    • hypovolemia
    • microthrombosis
    • metabolic derangements such as hepatic encephalopathy 
  • Signs:
    • weakness
    • altered mentation
    • loss of consciousness
    • confusion
    • coma
    • seizures
Q:

SIRS prognosis

A:
  • Very guarded to poor
  • ↑ # of organs failure ☞ worsen prognosis
  • Patients with pre-existing organ compromise 
    • ↑ risk of developing MODS as a result of critical illness
  • Mortality:
    • 20% if reach one organ
    • approximately 100% if reach 4 organ systems
Q:

Venom types

A:
  1. Cytotoxic
  2. Neurotoxic
  3. Coagulopathic/haemotoxic
Q:

SIRS

A:

Systemic inflammatory response syndrome

  • Systemic response to a variety of insults
    • NOT ONLY microbiological infections
    • Infectious or non-infectious insult to the body
  • Affects any patients of any age or fitness level
  • Early recognition of SIRS ☞ important to maximise a + outcome and prevent progression
    • difficult to recognise
    • clinical signs differs between species and individuals
    • Cats are challenging to diagnose
  • SIRS progression:
    • SIRS ☞ shock ☞ MODS ☞ MOF
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