Discussion Questions
Neurogenic shock is a type of shock that occurs because of dysfunction of the sympathetic nervous system (McCance, et al, 2009). The sympathetic nervous system is responsible for maintaining the normal tone of muscle and blood vessel walls. The dysfunction leads to relaxation and dilatation of the blood vessels. As a result, there is pooling of blood in the venous system and the effective end diastolic volume is reduced. There is an overall reduction in the blood pressure (McCance, et al, 2009).
In John Jackson's case, he has just suffered spinal cord injury as a result of the motorcycle accident, which has led to the neurogenic shock. This has caused a disruption in his sympathetic system and led to the cascade of events defined above. Therefore, although he has not suffered any blood loss as a result of the accident, he still suffers from shock as a result of his dysfunctional sympathetic system that has led to vasodilatation and pooling of blood in the periphery.
Meticulous wound management involves procedures such as cleaning, debridement, irrigation and excision (McCance, et al, 2009). It also involves dressing with the appropriate material at regular intervals. All these processes facilitate wound healing at the various stages. Cleaning ensures that the wound site is free of debris and particulate matter that could interfere with the proper process of wound healing because the cleaner the wound, the better the outcome of the healed wound. In addition, debridement involves the removal of all devitalized tissue from the wound; this also facilitates wound healing by ensuring the supply of oxygen and nutrients to the wound site, which also speeds up the healing process. Irrigation also removes all particulate matter from the wound site. Dressing with the appropriate material ensures that the wound is kept from contact pathogens and contaminants. The use of antibiotic-impregnated wound dressing material also ensures that the wound is sterile at all times and free of infection, which could also impede the process of wound healing. The administration of adequate fluids and nutrition would ensure that the individual continues to get the nourishment needed to meet all the metabolic demands of the body, part of which includes the repair of the damaged body tissue in the wounded area (McCance, et al, 2009). After a major burn, there is a hypermetabolic response leading to increase in oxygen consumption, metabolic rate, urinary nitrogen excretion lipolysis and weight loss which are all directly proportional to the size of the burn area. All these requirements are met by the body mobilizing nutrient stores, which are usually depleted rapidly. In burns patients, a lot of fluid is lost through the burnt area. It is important to continue replenishing estimated fluid losses so as to prevent dehydration. Early excision reduces blood loss (due to vasoconstrictive substances such as thromboxane, catecholamines, and natural edema planes that develop immediately after the injury) (McCance, et al, 2009). Burn excision is the removal of all necrotic tissue and the preservation of other viable tissue to increase the chances of better aesthetics and function of the part that has been burnt. The aim of grafting of a burnt area is to improve the cosmetic outlook of the burnt area and to reduce scarring. (Miminas, 2006).
Multiple organ dysfunction syndrome is a clinical syndrome characterized by development of progressive and potentially reversible physiologic dysfunction in two or more organs or organ systems of the body, which is caused by acute insult to the body, sepsis inclusive (Al-Khafaji, 2012).
In the CNS, some of the clinical manifestations of Multiple Organ Dysfunction Syndrome is Coma so an assessment of the level of consciousness is undertaken using the modified Glasgow coma scale for children. The score would help evaluate the child to know if the condition is improving or deteriorating. In the renal system, the amount of urine is assessed. Oliguria and anuria are clinical manifestations of MODS in the renal system. In the pulmonary system, MODS manifests as acute respiratory distress syndrome, which may lead to respiratory failure, the adequacy of respiration is assessed by pulse oximetry to assess the level of oxygenation of the blood. Cardiovascular, hepatobiliary system can be monitored by classifying hepatic encephalopathy if it is present. Moreover, other parameters that can be monitored include the bleeding and clotting times as they are also affected by liver failure (McCance, et al, 2009).
References
McCance, K.L., Huether, S.E., Brashers, V.L. & Rote, N.S. (2009). Pathophysiology: The biologic basis for disease in adults and children. Philadelphia: Mosby Elsevier
Demetrius, Miminas (2006). A critical review of early burn excision and grafting. Wounds UK, 2006, Vol 2, No 3.
Ali Al-Khafaji (2012). Multiple Organ Dysfunction Syndrome in Sepsis. Medscape Reference: Drugs, Disease & Procedures. Retrieved on 6th May 2012 from http://emedicine.medscape.com/article/169640-overview
