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Also known as acute kidney injury (AKI), is measured by the buildup of waste in your body and altered fluid levels because the kidneys are failing to do their job. The cause of the renal failure can also change the pathophysiology. There are three main causes: 1) decreased blood flow to the kidneys, 2) direct injury to the kidney/tissues, and 3) blockage of urine excretion. Inflammation to the kidneys or their structures (nephrons) can cause the kidneys to fail. Blockage of urine can cause a backup in the kidney, not allowing them to continue to filter out waste from the body or manage fluid levels.
There are many causes of kidney failure. For example, low blood perfusion to the kidneys can cause acute kidney failure from causes such as an infection/antibiotic use, hypotension potentially from blood loss (hemorrhage) or fluid loss (vomiting/ diarrhea), or even other organ failure (heart attack, liver failure). Another reason for kidney failure could be direct damage to the structures of the kidney itself. The biggest offender of kidney damage is sepsis, but also anything that can cause inflammation in the vessels of the kidneys (Vasculitis) as well as the attempt to treat it with too many NSAIDs can cause direct damage to the kidneys. Lastly, if the urine cannot be excreted, this can cause kidney failure. Kidney stones, enlarged prostates and some cancers can present problems for the urinary tract’s ability to excrete urine.
Return normal functioning of the kidney’s, including the nephrons, blood vessels, urethra, and ureters. Have the kidney labs be within normal limits and hopefully not have the patient on dialysis.
A decrease in red blood cells (RBC) or hemoglobin (HGB). The body uses the RBCs to transport Oxygen via HGB (HGB binds oxygen to the RBC). The oxygen is then bussed around the body and dropped off to the cells for the cell to perform cellular respiration creating ATP AKA energy. With oxygen (aerobic cellular respiration) the cells produce their ATP and have a byproduct of CO2, which we breath out. Without oxygen (anaerobic respiration) the cells use fatty chains to get their energy which has the byproduct of ketones (super acidic). Having the body be in a state of low oxygenation (hypoxia) creates an unbalanced pH which then denatures proteins making cells not be able to read their code/instructions because the code (DNA/RNA) is made out of proteins… While being anemic for short term is easier for the body to bounce back, long term anemic or rapid severe anemia is a bicycle kick to the body… AKA no good. It is important to note that you need BOTH RBCs and HGB for a working system of oxygenation.
There are many causes of anemia, the most life threatening is massive hemorrhage, but other causes such as lack of iron, severe burns, cancers, bone marrow disorders like multiple myeloma or leukemia can be just as detrimental.
Some of the types of anemia:
Stopping the cause of the anemia and returning the blood counts (RBC/HGB) back to normal limits.
Bronchoconstriction and increased mucus production decreases the ability to bring air into the alveoli, decreasing the amount of oxygenation red blood cells are able to exchange. This can also lead to increased amounts of carbon dioxide (CO2) retention due to lack of ability to exhale the CO2.
Swelling and mucus aggregated from an irritant or “trigger” cause difficulty in breathing, wheezing lung sounds and hypoxia. Triggers include dust, pollen, smoke, infection, etc. Asthma can also be genetic, environmental, triggered by exercise or from allergies.
Decreased work of breathing and proper oxygenation to tissues.
An electrical activity disturbance in the heart that causes an irregular and often rapid heartbeat. The atria quiver sending confusing electrical signals to the ventricles, leaving them unsure of when to contract thus beating irregularly. During atrial fibrillation, the heart is a less effective pump because of the quivering as well as not emptying completely. This causes the blood to pool and a clot can form. The clot can venture out of the heart into the lungs (PE), brain (stroke) or extremities (DVT).
The specific cause of atrial fibrillation is unknown but there are risk factors that put someone at higher risk of developing afib. Risk factors such as smoking, hypertension, and obesity as well as conditions such as diabetes or heart disease increase the likelihood that a patient may get atrial fibrillation. Post surgical interventions present a major risk for atrial fibrillation as well. Approximately 30%-40% of cardiac surgery patients develop atrial fibrillation.
Decreasing risks of clot formation, a heart rate within normal limits and rhythm control. The ultimate outcome is converting back to normal sinus rhythm, however, many people live with atrial fibrillation, especially if rhythm control doesn’t work or isn’t necessary.
Blood clots formed from any source, lodging in the patient leg or arm, impeding blood flow. This backup of blood pools in the extremity causing swelling, redness, warmth and pain.
Narrowing or occlusion of the vessels in an extremity. If caused by plaque (cholesterol and other substances) this could be from poor diet, lack of exercise, or genetics. However, blood stasis can cause aggregation of platelets and other blood products forming a clot that travels to the extremity (or heart, lungs or brain!). The most common cause of blood pooling (stasis) is Atrial Fibrillation (AFib). Other major causes are prolonged sitting, pregnancy, smoking, and birth control.
Stabilization of the blood clot or disintegration of the blood clot as well as prophylaxis treatment for future blood clots.
Cardiac muscle tissue death from lack of blood flow. The blood carries oxygen and nutrients to the cells. When this is decreased, cells die also called necrosis. Cardiac muscle cells dying is problematic as they do not regenerate (although there is some debate of this topic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042154/ )
Narrowing or occlusion of the cardiac vessels that perfuse the heart. The plaque that causes this could be from poor diet, lack of exercise, or genetics. It can also be from a deep vein thrombosis (DVT) that has broken free (embolus) and landed in the heart.
Re-perfusion to cardiac muscle and return of cardiac muscle functionality, or as much as possible.
Even after bone are done growing after childhood, bones are constantly being broken down and replaced. Bone truly is living tissue. Osteoporosis occurs when the production of new bone isn’t keeping up with what’s being broken down. There is primary and secondary osteoporosis. Primary osteoporosis is from the normal age-related bone loss, while secondary osteoporosis is due to some other disease process.
During younger years, bone is regenerated faster than old is broken down. Therefore, the overall bone mass will increase. Typically, bone mass peaks in the early 20’s. As individuals age they continue to break down bone, but the rate in which they produce new bone can’t keep up. If the patient had a high amount of bone mass when they peaked in their 20’s, they have more stored up, therefore the likelihood of developing osteoporosis with aging decreases.
There’s quite a bit that can put someone at a higher risk for developing osteoporosis. See the table below for a comprehensive list.
Address any underlying causes and prevent fractures
Pneumonia is essentially when fluid or pus gets trapped in the alveoli of the lungs (pictured below) and impaired gas exchange results. This can impact one or both lungs.
Below are the important differentiations of pneumonia (these definitions, except the first one, are from Cleveland Clinic). Establishing the kind of pneumonia is essential, in that the treatment course can differ.
The first picture below is normal, unobstructed gas exchange. If you look to the second picture, you see the alveoli have an accumulation of fluid in them, which impairs the gas exchange that should occur to provide appropriate oxygenation into circulation. What results is coughing (many times producing phlegm), fever, chills, chest pain or pain when coughing, or cold/flu like symptoms. Inflammation can also occur. Antibiotics are administered, and the choice of which is dependent upon the offending pathogen, any other medical conditions going on with the patient, and if there are any antibiotic resistances present . Oral antibiotics are given typically for community-acquired pneumonia, however if the patient is hospitalized, they will most likely receive IV antibiotics. Steroids are typically administered to address inflammation.
Pneumonia can be caused by a virus, bacteria, fungus, or from inhaling something (a chemical, inhalant, or aspirating on food or fluid). This can be of particular risk to those with a weakened immune system or unable to keep your own airway clear (for example, unable to cough or maintain consciousness due to neurological or other injury).
Resolve the infection, optimize gas exchange, minimize impact from impaired gas exchange.
Essentially, at its most basic level, respiratory failure is inadequate gas exchange. Not enough oxygen is being exchanged in your lungs, and therefore it’s not getting into circulation.
There are three main types:
Your body desperately needs oxygenated blood to function. Therefore, if you’re not getting good gas exchange in the lungs and oxygenating your blood, your organs will suffer.
Many situations and/or conditions can result in respiratory failure. Trauma, medication (oversedation, for example), various disease processes (COPD, asthma, PE, pneumonia), damage to the actual lungs/surrounding tissue/spinal cord or nerves supporting the lungs/brain, and inhalation injuries are the major ones.
Restore oxygen levels of blood as appropriate and remove excess carbon dioxide
Essentially, skeletal muscle is destroyed (for various reasons) and their intracellular contents (in particular myoglobin) leak into the bloodstream. The kidneys can’t handle this large amount of myoglobin and it can damage them, and in some cases (roughly 30-40% of patients with this develop acute renal failure) can cause kidney failure.
Quite a few things can cause this. One that has been discussed more frequently recently is due to the increase in people engaging in high-intensity workouts (like CrossFit). This causes intense muscle breakdown, which can result in this condition. Trauma can also be a cause, as well as conditions of genetic origin, seizures, metabolic issues, temp-regulating issues, and many medications. A few medications that can cause this to occur include statins, diuretics, aspirin overdose (salicylate toxicity), recreational drugs like cocaine and amphetamines, and narcotics.
The exact patho of RA is not fully understood, although there is thought to be a genetic component leading to more susceptible individuals. Essentially, something triggers the immune response (that something could be an infection, trauma, or something of that nature) and this leads to synovial hypertrophy (synovial lining of the joint) and chronic inflammation of the joint(s).
Basically, this inflammation becomes uncontrolled and leads to the destruction of bone, cartilage, and even tendons, ligaments, and blood vessels.
Chronic inflammation and degenerative changes are the hallmark aspects of RA.
Like the pathophysiology, the etiology is unknown. However there are some factors that seem to contribute to its occurrence. These factors include genetics, various infections, sex hormones, as well as immunological factors.
There is no cure for RA, therefore the goal is to manage symptoms and slow the disease progression. NSAIDs, steroids and DMARD’s are used, physical and occupational therapy are key, and in severe cases surgery and joint replacement may be necessary. Some alternative therapies like fish oil, tai chi, and various plant oils have demonstrated improvement in RA symptoms.
Seizures are a very complex neurological issue. Here is the definition from Medscape of a seizure: “a seizure results when a sudden imbalance occurs between the excitatory and inhibitory forces within the network of cortical neurons in favor of a sudden-onset net excitation” (source). Basically, abnormal electrical discharges are occurring in the brain. There are different kinds of seizures (epileptic, focal-onset, general-onset).
The exact cause of a seizure can be extremely difficult to pinpoint. John Hopkins Epilepsy Center divides seizures into two categories: provoked and unprovoked.
The etiology of provoked seizures can include: trauma, drugs or alcohol, tumors, medications, drug withdrawal, progressive brain disease, and more.
The etiology of unprovoked (or “natural”) seizures can include: fever, infection, metabolic issues, genetics, Alzheimer’s disease, and more. (Source link listed below)
Stop any current seizure activity as soon as possible, minimize damage, and prevent it from occurring in the future.
Sepsis is essentially an overactive/uncontrolled immune response to an infection. The immune system kicks into overdrive, for whatever reason, and cannot be calmed down. It’s like someone turned the dial all the way up on the immune system and ripped the dial off the dashboard. As the healthcare team, we are trying to turn the immune response down as best we can… but it is VERY challenging. This is a very complex issue which affects many body systems, with an overall mortality rate anywhere from 27-36% (and higher in patients in intensive care settings). The challenge is that it can present with very subtle symptoms and progress quickly. Time is of the essence in sepsis recognition and treatment.
Essentially, the cause of sepsis is the original infection. Examples include pneumonia, urinary tract infection, infection in the bloodstream (bacteremia), etc. It doesn’t have to be a bacterial infection, it can be a virus or a fungus as well.
Lessening the immune response, prevention cellular death, resolution of infection, minimizing damage from cellular oxygen deprivation and lactic acid build up, maximizing cardiac output and resolution of the condition.
A stroke is essentially a neurological deficit caused by decreased blood flow to a portion of the brain. They will be classified as either hemorrhagic or ischemic. An ischemic stroke is the result of an obstruction of blood flow within a blood vessel. A hemorrhagic stroke is when a weaken blood vessel ruptures and blood spills into the brain where it shouldn’t be. Both of these can cause edema and cellular death. Lack of blood flow for greater than 10 minutes can cause irreversible damage.
Various things can cause an ischemic stroke, which comprises approximately 85% of all strokes. Some of those who are at highest risk are those on anticoagulation therapy. People are on anticoagulants therapy for various reasons (mechanical heart valves, atrial fibrillation, etc.) and if they become sub therapeutic and therefore their blood is too thick, a clot can easily form and end up in the brain, causing an ischemic stroke. Diabetes is also one of the major risk factors, in addition to atherosclerosis, hypertension, cardiac dysrhythmias, obesity, substances abuse, and oral contraceptives. Hemorrhagic strokes (the remaining 15% of strokes) can be caused by an aneurysm rupture (which are very difficult to predict… frequently noted increased incidence in smokers, drug abuse, and people with family history of a first-degree relative with one), high blood pressure, or the rupture of an arteriovenous malformation (which is genetic).
Restoring as much blood flow as possible as quickly as possible, and minimizing cellular death/damage is key. Clot-busting meds can be given to restore blood flow for ischemic strokes. Hemorrhagic strokes are managed by keeping the blood pressure controlled, controlling intracranial pressure, reversing any anticoagulants on board, and even very invasive procedures or surgery to relieve increased intracranial pressure. You want the patient to gain back as much function as possible. This is done slowly over time by the brain creating collateral circulation around the infarcted area. Physical, occupational, and speech therapy are essential aspects of stroke recovery. Some patients may make a complete recovery, while others may have profound deficits.
Syncope is essentially a loss of consciousness, which is typically caused by hypotension. The brain lacks adequate blood flow and a temporary loss of consciousness results.
Syncope typically has a cardiac etiology, but can also be due to many other things (like a side effect from a med, neuro issue, psych issue, or lung problem). When a cardiac etiology is suspected, a cardiac workup is completed. This typically includes cardiac monitoring, labs, and routine vital signs (specifically blood pressure and heart rate).
No additional syncopal events, no injury, identification of cause and treatment to prevent further episodes
Infection within the genitourinary system, which then causes inflammation. The urinary tract is sterile above the urethra and pathogens gain entrance via the perineal area or the bloodstream. When these pathogens enter this sterile environment, infection ensues.
One can acquire an infection in the bladder itself (cystitis), or the an infection in the urethra (urethritis), which is essential a urinary tract infection.
Females are most prone to UTI’s due to their natural anatomy. Females have a shorter urethra and it has a close proximity to the anus (and therefore e. Coli, which is normally found in the GI tract). Males become more susceptible as they age due to urinary stasis. Urinary catheter use (particularly indwelling) significantly increase the risk for a UTI, sexual intercourse, certain birth control methods (spermicide, diaphragms), blockages in the urinary tract, abnormalities in the anatomy of the urinary tract, or a suppressed immune system can all increase the risk for a UTI.
Resolution of infection, restoration of normal bladder functioning