COMPOUNDING INSULT
C/F Rx
1.simple resuscitation
fluid
High flow O2(face mask)
2.Global approach
inotropes/vasoactives
(dobu,enoxamine,piroximone,milrinone,amrinone)
3.Regional approach
regional perfusion measured by
renal output renoprotectives
adult mannitol ml/bw
child frusemide
infant renal dose dopa
(increase output but cant increase perfusion
rather increase CO)
Gut luminal Ph/PCo2/acidosis
Fluid+blood+inotrop(dobu+dopex)
4.avoidig nosocomial infection
Rx nosocomial pneumonia(spillage from UGIT)
Avoid H2 blocker
Use sucralfate
SDD()-destruct pathogen bt maintain commensal anaerobe
5.Rx enotoxaemia
anti endoxin antibody
active immunization before major surgery
bacterocidal/permeability protein
endotoxin neutralizing protein
dextran-polymixin-B conjugate
SIRS
responsible agents Rx
1.cytokines:mobilization,localization and activation I . Ab to TNF-alpha, IL1
of leukocytes by TNF-alpha, IL1 II . low dose dexamethason
(inhibit synth,secretion
high dose—failure)
2.Arachidonic acid metabolites
(play role in MODS) Ibuprofen
protective-PGE2 Indomethacin
Cox inhibitors
deleterious-(Lt, Tx)
3.Degranulating Neutrophils
release free radicles super oxide.dismutase
microvascular injury Allopurinol
vit-C
4.contact,coagulation,compliment activator
(DIC due to imbalance bet pro & anti coagulants) Anti Thrombin III
C1 esterase
5.Endogenous Anti inflammatory agents Anti IL-1, Anti TNF-alpha
regulating IL1,TNF-alpha IL-10(macrophage deactivator)
6.NO
as vasodilator—septic shock block by NMMA(Ng-monomethyl
-arginine)
( restore vascular resp to catecholamine )
modify neutro-plat interaction---MODS(by
microvas occlution)
ARDS-admin NO
(it increases O2 supply by pulm vasodilation
without any syst effect-decreases PA pressure)
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