Principles of Management : Multi Organ Failure

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* Day 6 – 7 /ABC
* ABC
Principles of Management :
Multi Organ Failure
/MODS

* PRINCIPLES OF MANAGEMENT :
ABC / Multi Organ Failure (MODS)
* Multiorgan dysfunction syndrome (MODS) is the progressive dysfunction of more than one organ in patients that are critically ill or injured. * It is the leading cause of death in intensive care units (ICUs). * The initial insult that stimulates MODS may result from a variety of causes including, but not limited to, extensive burns, trauma, cardiorespiratory failure, multiple blood transfusions, and most commonly, systemic infection. (Schumaker, 2006) * The term MODS has been referred to interchangeably as systemic inflammatory response syndrome (SIRS) and multisystem organ failure (MSOF). (Schumaker, 2006) *

A. Determination and Management
Multi Organ Failure: Etiology and Risk Factors
* Causes of MODS include:
* dead tissue
* injured tissue
* infection
* perfusion deficits
* persistent sources of inflammation such as pancreatitis or pneumonitis * High Risk for developing MODS :
* Impaired immune responses such as older adults
* clients with chronic illnesses
* clients with malnutrition
* and clients with cancer
* Clients with prolonged or exaggerated inflammatory responses are at risk, including victims of severe trauma and clients with sepsis * Multi Organ Failure: Classification
* 1. Primary MODS –
* results directly from "a well-defined insult in which organ dysfunction occurs early and is directly attributed to the insult itself.“ * The direct insult initially causes a localized inflammatory response that may or may not progress to SIRS. * An example of primary MODS is a primary pulmonary injury, such as aspiration. * Only a small percentage of clients develop primary MODS. * Multi Organ Failure: Classification

* 2. Secondary MODS
* is a consequence of widespread systemic inflammation, which develops after a variety of insults, and results in dysfunction of organs not involved in the initial insult. * The client enters a hypermetabolic, state that lasts for 14 to 21 days.. * During this body engages in autocatabolism : which causes changes in the body's metabolic processes. process can be stopped,. the outcome for the death.

* Secondary MODS occurs with condition septic shock and ARDS. (Black,2005 , p2474) * Multi Organ Failure: Clinical Manifestations
* There is usually a precipitating event to MOD:
* aspiration,
* ruptured aneurysm
* Septic shock which is associated with resultant hypotension. * The client is resuscitated; the cause is treated; and appears to do well for a few days. * The following possible sequence of events often develops. * Multi Organ Failure: Clinical Manifestations

* The client experiences SIRS before MODS Within a few days * there is an insidious onset grade fever, tachycardia, increased numbers and segmented neutrophils on the different count (called a left shift), * dyspnea with the diffuse patchy infiltrates on the chest x-ray client * often has some deterioration in mental reasonably normal renal and hepatic laboratory results * Multi Organ Failure: Clinical Manifestations

* Dyspnea progresses, and intubation and mechanical ventilation are required. * Some evidence of agulopathy (DIC) is usually present.
* The client is usually stable hemodynamically and has relative polyuria, an increased in cardiac index (greater than 4.5 l/min), * Systemic vascular resistance of less 600 dynes cm-5 Clients often have increased blood glucose level in the absence of diabetes * Multi Organ Failure: Clinical Manifestations

* Between 7 and 10 days:
* Bilirubin level increases and continues to increase, followed serum creatinine. * Blood glucose and lactate level continue to increase because of the hypermetabolic state. * Other progressive...
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