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Sepsis, Septic shock, SIRS Actual Updated
Questions And Answers
sepsis definition/requirements - CORRECT ANSWER ✅✅systemic response to infection, manifested by 2 or more of the following from infection:
- temp >38 or < 36
- HR > 90
- RR > 20 or PaCO2 < 32
- WBC >12,000, < 4000, or 10% bands sepsis = SIRS criteria + infection severe sepsis - CORRECT ANSWER ✅✅sepsis + organ dysfunction, hypoperfusion, or hypotension BUN and Cr increased septic shock - CORRECT ANSWER ✅✅sepsis-induced shock w/hypotension depsite fluids and tx. may include lactic acidosis, oliguria, or acute decline in mental status SIRS Criteria - CORRECT ANSWER ✅✅Must have 2 or more of the following:
- temp >38 or < 36
- HR > 90
- RR > 20 or PaCO2 < 32
- WBC >12,000, < 4000, or 10% bands look for trends
(don't have to be septic to have SIRS) pathophysiology of septic shock - CORRECT ANSWER ✅✅immune/inflammatory system - systemic response --> endothelial and coagulation dysfunction --> massive peripheral vasodilation and increased capillary permeability --> maldistribution of blood --> decreased perfusion to cells --> impaired ventricular function --> hypermetabolic state --> increase in O demand and cell hypoxia --> inability of cells to use O2 - -> apoptosis --> MODS and death SVO2 w/septic shock - CORRECT ANSWER ✅✅normal = 60-80, anoumt of O delivered back to tissues- how well tissues are using O Early septic shock: HIGH SVO2 (not utilizing O2- even if we give them O2, they cannot use it, SVO2 >80) septic shock diagnosis - CORRECT ANSWER ✅✅suspected infection, 2 or more SIRS criteria, evidence of at least one organ dysfunction clinical manifestations of septic shock - CORRECT ANSWER ✅✅CV: persistent decrease BP requireing vasoperssor therapy despite adequate volume resuscitation Pulmonary: PaO2/FiO2 ratio less than 300, indicating ALI lactic acidosis, oliguria, change in mentation initial stage of septic shock (warm, hyperdynamic, early stage) - CORRECT ANSWER ✅✅massive vasodilation, decreased preload (decreased CVP, PAS/PAD, PAWP), decreased afterload (decreased SVR), tachycardia, high CO and CI despite impaired contractility
crystalloids and/or colloids management of septic shock - CORRECT ANSWER ✅✅fluid administration, vasoperssors, inotropes, art line, MAP > 65, mechanical ventilation (pressures/volumes to decrease ALI), cultures, serum lactate levels, glucose control, abx therapy, stress ulcer prophylaxis (PPI or H2-antagonist), nutritional support (25-30 kcal/kg), platelets for < 5000, PRBC for Hgb < 7, iv hydrocortisone cultures for septic shock - CORRECT ANSWER ✅✅blood X2, urine, sputum, wound first ABx w/in 1 hour of severe sepsis diagnosis glucose control for septic shock - CORRECT ANSWER ✅✅important! high sugar can increase risk of infection to want tight glucose control have IV insulin drip to maintain glucose < 150 PaCO2 - CORRECT ANSWER ✅✅indicates ventilation PaO2 - CORRECT ANSWER ✅✅indicates oxygenations assess total oxygenation - CORRECT ANSWER ✅✅look at PaO2, SPO2, Hbg IV hydrocortisone for septic shock - CORRECT ANSWER ✅✅if unresopnsive to fluids and vasopressors, then check cortisol levels relative adrenal insufficiency (shock-type affect) can revert w/solucortef (to increase cortisol)
SIRS response - CORRECT ANSWER ✅✅local inflammatory response vascular response: increased permeability neutrophil response: move to area of injury plasma protein response platelets SIRS - CORRECT ANSWER ✅✅widespread inflammation, may result in MODS MODS - CORRECT ANSWER ✅✅Multiple organ dysfunction syndrome progressive failure of 2 or more organ systems primary or secondary primary MODS - CORRECT ANSWER ✅✅well-defined injury (initial injury) secondary MODS - CORRECT ANSWER ✅✅consequence of systemic inflammation, dysfunction of organs not involved in initial insult MODS organ dysfunctions - CORRECT ANSWER ✅✅GI: loss of gut's barrier function - bacterial transloactiona hepatobiliary: changes in protein/fat/carb metabolism, loss of kupffer cells and detox ability, ischemic hepatitic (necrosis), gall stones from inflammation pulmonary: ALI renal: acute renal failure, ATN
