Multiple Organ Dysfunction Syndrome

D10 NURS 226

>> Hello Dr. Burns.

How are you today?

>> Very well, nurse Jackie.

Today, we are here to discuss
multiple organ failure,

a very important subject
in the medical field.

>> Multiple organ failure

after trauma is still a leading
cause of post-injury death.

Now it has been proven

that excessive systemic
inflammation following trauma

participates in the development
of multiple organ failure.

This means that severe
inflammation, infection,

or sepsis of the body
and its organs leads

to organ dysfunction,
severe trauma, with muscle

and tissue damage can
also cause this condition.

>> It has also been shown
that patients who receive six

or more units of blood
represent a higher risk group

for the development of
multiple organ failure.

Studies also indicate that
multiple organ failure

after trauma is established
within 24 hours of injury

in the majority of
patients who develop it.

It appears that multiple
organ failure already presents

at the time when
medical staff are trying

to predict whether
or not it will occur.

>> Well, Dr. Burns,
what are the symptoms

of multiple organ dysfunction
after a severe trauma?

>> The symptoms depend on
which organ system is failing.

For example, if the
kidney fails,

the patient will
have fluid retention

and blood pressure fluctuations.

And if the liver fails,
you can add jaundice

and some itching to that list.

>> If the respiratory
system fails,

the patient will have
poorly-oxygenated blood

and the heart muscle
will not function well.

>> Without adequate
oxygenation, the liver

and kidneys do not function well
either, but are not as sensitive

to low oxygen as the heart.

When the heart begins to fail,

it cannot properly pump
the blood through the body

and the backup of blood causes
fluid to leak into the tissues,

resulting in pulmonary edema.

The lungs fill with fluid,

further restricting
oxygenated blood to the body.

The end result is a
vicious cycle that ends

in cardiopulmonary collapse.

>> So, Dr. Burns, what
is the medical management

for multiple organ dysfunction?

>> Well, Nurse Jackie,
I am glad you asked.

At the present time,
there is no drug

that can reverse multiple
organ dysfunction.

Therapy is limited
to supportive care,

maintaining adequate
vital signs,

and especially tissue
oxygenation.

Mortality varies from 30 percent
to 100 percent, where the chance

of survival is diminished
as the number

of organs involved increases.

The mortality rate has not
changed since the 1980s.

>> Oh, Dr. Burns, what can we,
as nurses, do to promote home

and community-based
care for these patients?

And what about long-term care?

>> The challenge to
these patients is

to support physiologic
function while minimizing new

organ dysfunction.

In a recent study, multiple
organ failure occurred

in 47 percent of trauma patients
and was significantly associated

with long-term survival
and functional status.

Out of 322 patients, 75
percent were still alive

at a two-year follow-up
after discharge from the ICU.

>> Yes, that is such
great news, Dr. Burns.

Do these patients go home
with home health care

or just supportive care,
and when do we know

when to discharge life support?

>> Very good questions,
nurse Jackie.

I see you have been
doing your research

on multiple organ dysfunction.

It's always wonderful to
see nurses keep learning,

even after they get their
degrees from Greenville Tech.

Well, severe head
injury has been reported

to be the leading
cause of both early

and late deaths after trauma.

The results show a strong
relationship between the degree

of organ failure
immediately after injury

and the patient's functional
status at discharge.

These patients were
four times more likely

to require assistance in
activities of daily living more

than two years after trauma,
compared to trauma patients

without organ failure.

>> And there was no significant
difference regarding self-care

among patients with
multiple organ failure

versus a single organ failure.

More than two years
after severe trauma,

only half of the ICU
survivors had fully recovered

with resumption of
a normal life.

>> Um, excuse me.

However, most of these
patients were able to look

after themselves without
outside resources, however,

discharge of life support must
be a well thought-out decision

that is based on many things.

Patient status, chance
of survival,

and patient's wishes
to be considered.

That is never an easy choice,
but one that sometimes has

to be made in the best
interest of the patient.

>> That is so wonderful to hear.

Not the life support
part, but the part

about the patients going
home with little to no help.

>> Kind of makes me
happy, too, nurse Jackie.

>> Thank you for clarifying
multiple organ dysfunction

syndrome with me
today, Dr. Burns.

It is something I will
take back to the floor,

and tell the other
Greenville Tech nurses about.

I think Nurse Shieldy
[assumed spelling]

and Nurse Mance [assumed
spelling] will really enjoy it.

>> Back to the ER Trauma
Bay for me, and you need

to get back to the floor.

>> Multiple organ dysfunction
syndrome was brought to you

by Sammy Ping [assumed
spelling], Natasha Freeman,

Lori Baker, Jesse
Randolph, Reggie Shields,

Sherri Tucker, and Sonia Benson.