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.
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.
Trauma, especially sepsis and burns. Burns,
we will call that as being our Curling ulcer.
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.
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.
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.
Prophylaxis. Maintain pH greater than 4, endoscopic
or surgical therapy is rarely necessary.
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.