smooth surface of the endothelium. This consumes plates and inhibits clot lysis. This progresses to uncontrolled alterations in the vascular tone with vasodilation. In severe sepsis, the balance between vasodilators(nitric oxide) and vasoconstrictors(endothelin) cannot be maintained. Consequently, the maldistribution of blood flow in addition to loss of vascular tone at the macro and microvascular levels results in ischemia and hyperemia in the cells. Myocardial depressant factor is also released and may contribute to the loss of the compensatory CO that is required to keep blood moving through the vascular beds.
Septic shock is a subset of sepsis(4th on the continuum), in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality. It is a type of vasodilatory or distributive shock that is severe sepsis with cardiovascular dysfunction(primary loss of vascular tone). Patients with septic shock can be identified with a clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP >65mmHg and having a serum lactate level >2mmol/L(18mg/dL) despite adequate volume resuscitation.
MODS(Multiple organ dysfunction syndrome) refers to a progressive organ dysfunction in an acutely ill patient, in which homeostasis cannot be maintained without interventions. It is at the severe end of the sepsis spectrum because it involves both infectious(sepsis, septic shock) and noninfectious conditions(SIRS). MODS can be broken further into primary or secondary. Primary MODS is when organ dysfunction occurs early and can be attributable to itself. Secondary MODS is organ failure that is not in direct response to itself, but is a consequence of the host’s response.
(Baird, 2016 p1009; Neviere, 2017)
Risk factors
• Family or personal hx of tobacco abuse, hyperlipidemia, hypertension, diabetes, obesity, stress, sedentary living, cardiovascular disease, renal insufficiency, clotting disorders, foot ulcers, or noncomplicance with medical management Pt has history of smoking, hyperlipidemia, hypertension, diabetes, obesity, cardiovascular disease, renal insufficiency, and foot ulcer!
• Age <50 years, w/ diabetes and one other atherosclerosis risk factor (smoking, dyslipidemia, HTN, or hyperhomocysteeinemia)