Sepsis/Shock

Question 1

Recite the shock CPG

Answer 1

Question 2

Recite the normal saline dose table for shock

Answer 2

***In the sepsis guideline, they get half the dose

E.g. elderly etc = 500mls, All other patients 1000mls

Question 3

What is shock?

Answer 3

Shock is a state of cellular and tissue hypoxia due to either reduced oxygen delivery, increased oxygen consumption, inadequate oxygen utilisation, or a combination of these processes

The strongest indication of shock is usually profound hypotension, but this pay be transiently offset by a compensatory tachycardia

Question 4

Besides hypotension, what are other signs and symptoms of shock?

Answer 4

• altered conscious state
• tachypnoea
• diaphoresis, pallor, cold
• hot, flushed (due to vasodilation)
• increased thirst

Question 5

Can you ambulate a patient in shock?

Answer 5

• NO! Do not stand or walk the patient
• extricate supine or sitting (as appropriate)

Question 6

What IV access do you need for your shock patient?

Answer 6

• 18g IVC or larger
• or larger in CF

Question 7

Sepsis should be suspected when…

Answer 7

• there is a known or suspected source of infection (+/- risk factors for sepsis or SIRS criteria) and SBP <100mmHg

Question 8

When should you give a reduced max fluid dose?

Answer 8

• Elderly
• hx chronic renal failure
• hx cardiac failure

Question 9

What do all other patients receive for IVT under the sepsis guideline?

Answer 9

1000ml

Question 10

What do you do if transport time is >30 mins to hospital

Answer 10

Consult receiving hospital for Ceftriaxone 2g IV

Question 11

What are signs and symptoms of sepsis?

Answer 11

• General
  
  • fevers, chills, riggers, malaise
• Neurological
  
  • altered mental status or acute deterioration in ADL’s, headache, meningism
• Respiratory
  
  • cough, dyspnoea
• Abdominal
  
  • pain, rigidity, tenderness guarding, swelling
• Genitourinary
  
  • dysuria, urinary frequency or urgency, haematuria
• Skin
  
  • cellulitis (erythema, oedema, warmth, pain)
  • petechial rash
  • septic arthritis (joint pain, swelling, warmth)
  • Infected wound or abscess (erythema, swelling, pain, prurient discharge)

Question 12

What are some risk factors for sepsis?

Answer 12

• neutropenia, recent chemotherapy or other immunocompromise
• recent pneumonia, COPD
• recent trauma/surgery/procedure or hospital stay in the last 6 weeks
• indwelling medical devices (e.g. IDC, SPC, CVC, PEG

Question 13

What is the SIRS criteria?

Answer 13

• <36 degrees or >38 degrees
• HR >90
• RR >20

Question 14

Define sepsis.

Answer 14

• Sepsis is defined as ‘life-threatening organ dysfunction caused by a dysregulated host response to infection’
• = organ dysfunction + infection

Question 15

pathophysiology of sepsis

Answer 15

• septic shock results when infectious microorganisms in the blood stream induce a profound inflammatory response causing haemodynamic decompensation
• the pathogenesis involves a complex response of cellular activation that triggers the release of a multitude of pro inflammatory mediators
• it can lead to tissue damage, organ failure and death

Question 16

Why is there a reduced fluid dose in sepsis?

Answer 16

• septic patients may be hypovolaemic due to decreased fluid intake during illness; third spacing of vascular fluid, vasodilation and increased fluid loss through acidosis-driven tachyonoea, febrile diaphoresis and intestinal hyperpermeability - fluid may therefore be required to restore intravascular volume, cardiac output and tissue oxygen delivery - research has not clearly identified the optimal fluid volume to be used in sepsis resuscitation. However aggressive fluid resuscitation may cause harm. - therefore recommended fluid volumes are more conservative than in other forms of shock