Stress Ulcer

00:01 Stress ulcers is my next topic. Now about stress ulcers, amazingly, there could be so much stress that's taking place in your patient physiologically that literally, this is causing ulceration.

00:15 Let's talk about this. Gastric mucosal ischemia with superficial ulceration due to underlying illness such as trauma, sepsis, burns. Those are stressful situations. Extreme physiologic stressors.

00:31 Trauma, especially sepsis and burns. Burns, we will call that as being our Curling ulcer.

00:41 Cushing's Triad, you have the three following. Bradycardia, hypertension and irregular respiratory rate. Now the exact theory behind it, well, there are many out there.

00:53 If you wish to further look into it by all means please do so. At this point, I would recommend you highly and quickly memorize bradycardia, hypertension, irregular respiratory rate. But you begin with the head trauma first. And because of such intense physiologic stress may actually cause what's known as a Cushing's ulcer to the point where it actually perforate. Then we have Curling. Another type of extreme physiologic stress ulcer. A Curling ulcer would begin with the fact that your patient is suffering from a burn. Burn. That's where you begin here. Okay, how you do this. If I were you, I'd probably take the "UR" in bURn and put it with "UR" in cURling. That is going to be specific.

01:44 Head trauma will be Cushing. The Cushing's triad as I told you earlier, hypertension, you're going to have bradycardia, altered respiratory rate. ICP stands for increased cranial pressure or intracranial pressure due to a space occupying lesion. All of this is known as Cushing Triad.

02:06 Prophylaxis. Maintain pH greater than 4, endoscopic or surgical therapy is rarely necessary.

02:13 Remember, if you know that your patient is coming in with a burn or head trauma and you know that your patient is at risk for these physiologic stress ulcers in the stomach, wouldn't it be nice to perhaps keep your pH a little bit higher. Remember, this pH of greater than 4, we're talking about not in the plasma, for pete sakes. In the plasma, pH is normally 7.350 to 7.45. We're talking about gastric luminal pH so please be smart about what exactly or how you are exercising prophylaxis with these physiologic stress ulcers. You know this, you'll be in good shape. And you answer this question, you'll get your 260, 272. And these are real life stories.