Page 244 - Critical Care Notes

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MULTISYS
■ Hemorrhage or shock
■ Surgical complications
■ Acute pancreatitis
■ Burns, extensive tissue damage, and/or necrotic tissue
■ Aspiration
■ Multiple blood transfusions
■ Inadequate fluid resuscitation
Signs, symptoms, and management are similar to those for sepsis, severe
sepsis, and septic shock. Initial organ failure includes the cardiovascular, pul-
monary and renal systems and can progress rapidly to the neurological, hema-
tological, hepatic, metabolic, and GI systems.
■ Monitor for decreasing SBP, MAP, O 2 saturation, urine output, platelets,
bilirubin, alkaline phosphatase, aspartate aminotransferase, alanine amino-
transferase, serum lactate, and a Glasgow Coma Scale <15 with changes in
mental status.
■ Monitor for increasing respiratory rate, coagulation times, and creatinine
level.
■ There is also an increased risk for DIC.
■ The need for dialysis is an early warning sign of MODS.
■ The Sequential Organ Failure Assessment score (SOFA score) can be
calculated online at http://www.mdcalc.com/sequential-organ-failure-
assessment-sofa-score/
Trauma
Pathophysiology
■ Blunt trauma: Resulting from motor vehicle crashes (MVCs), falls, blows,
explosions, contact sports, and blunt force injuries (e.g., from a baseball bat).
■ Estimating the amount of force a person sustains in an MVC = person’s
weight × miles per hour of speed.
■ During an MVC, the body stops but the tissues and organs continue to
move forward and then backward (acceleration-deceleration force).
■ Penetrating trauma: Resulting from gunshot wounds, stabbings, and
firearms or implement (missile, shrapnel) injuries.
■ There is direct damage to internal structures, with damage occurring
along the path of penetration.
■ Penetrating trauma usually requires surgery.
■ Traumatic brain injury (TBI): Resulting from a skull fracture, concussion,
contusion, cerebral hematoma, and diffuse axonal injury.

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