1. [From 10$/Pg] 12 Pm Unread Multiple
[From 10$/Pg] 12 Pm Unread MultipleAmelia MangunePosted DateMay 19, 2022, 6:12
PMUnreadMultiple organ dysfunction syndromes (MODS) or multiorgan system failure,
commonly associated with critical illness, is defined by the coexisting presence of
physiologic dysfunction and/or failure of two or more organs (Kress & Hall, 2018). Based on
the authors, this syndrome emerges in the setting of severe sepsis, in any type of shock,
severe inflammatory disorders such as pancreatitis, and trauma. Recently at work, we cared
for an 83y/o male patient who presented in the ED with GI bleed due to a perforated gastric
ulcer. Patient has a history of DVT on Eliquis, HTN, and ETOH abuse. Patient had laparotomy
and Graham Omental Patch, and extensive abdominal lavage. The patient remained
intubated after the surgery and extubated after several days. After a few days, patient
spiked a fever, and further lab findings include elevated Lactic acid, leukocytosis, and
elevated Procalcitonin. CT Chest and abdomen/pelvis were ordered. Reports came back
with pneumonia and a gastric leak. Patient was treated with IV antibiotics, and the surgeon
performed another laparotomy and a repair of the omentum. Patient came back to ICU
extubated from surgery. In the early morning after surgery, the patient became obtunded,
hypotensive, tachycardic, developed acidemia, was eventually intubated, and was started on
pressors and sodium bicarb drip. Also, the patient was found to be in acute kidney failure; a
nephrology consult was called and recommended dialysis. Unfortunately, the patient did
not survive because of MODS caused by septic shock.The differential diagnoses for this
patient’s case fall in low-output shock states, including hypovolemic shock, cardiogenic
shock, and obstructive shock. Based on Neviere (2022), as the severity of shock worsens
(e.g., cool skin and cyanosis), organ dysfunction develops (e.g., oliguria, acute kidney injury,
altered mental status). Notably, the presentation is nonspecific, such that many other
conditions (e.g., acute respiratory distress syndrome) may present similarly. Thus,
according to Felner & Smith (2017), the management of severe sepsis and septic shock
requires a structured process that ensures proper diagnostic evaluation and the
implementation of evidence-based interventions expediently to improve outcomes. This
approach requires (1) empiric antibiotic coverage of an infectious source while cultures are
pending, (2) optimal fluid resuscitation, (3) pressor and/or inotrope treatment for specific
patients, and (4) review of additional treatments such as drainage of abscesses, removal of
lines, moderate (but not intensive) control of hyperglycemia (as required), and (5)
consideration of steroids in specific patient subsets when indicated.In general, the greater
the number of organ failures, the higher the mortality, with the most significant risk being

2. associated with respiratory failure requiring mechanical ventilation (Neviere,
2022).ReferencesFelner, K. & Smith, R.L. (2017). Sepsis and shock. In McKean, S.C., Ross, J.J.
Dressler, D.D. & Scheurer, D.B. (Eds.). Principles and Practice of Hospital Medicine (2nd ed.,
Chap. 141, pp. 1121-1122). McGraw-Hill Education. Kress, J.P. & Hall, J.B. (2018). Approach
to the patient with critical illness. In Jameson, J.L., Kasper, D.L., Longo, D.L., Fauci, A.S.,
Hauser, S.L. & Loscalzo, J. (Eds). Harrison’s Principles of Internal Medicine (20th Ed, Vol.2,
Part 2, Chap. 293, p. 2027). McGraw-Hill Education. Neviere, R. (March 07, 2022). Sepsis
syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and
prognosis. UpToDate. https://www.uptodate.com/contents/sepsis-syndromes-in-adults-
epidemiology-definitions-clinical-presentation-diagnosis-and-
prognosis?search=multiorgan%20dysfunction%20syndrome&source=search_result&select
edTitle=1~150&usage_type=default&display_rank=1#H10