140 - Collapse/Sepsis

Question 0

What are the signs of shock?

Answer 0

Collapse
Altered conscious level
High HR
Low Bp
High Resp rate
Poor peripheral perfusion
Low urine flow

Question 1

What type of shock is sepsis?

Answer 1

Maldistributive

Question 2

What is the difference between Maldistributive shock and other forms of shock?

Answer 2

Maldistributive is a primary failure to control peripheral circulation, leading to cardiac and organ dysfunction.
Other forms of shock have reduced cardiac output and reduced O2 delivery which leads to a secondary failure to control peripheral circulation

Question 3

How would you respond if someone presents with signs of shock?

Answer 3

ABCDE
15l/min O2
1.5L of Hartmann’s or saline (any crystalloid) or less amount of a colloid if you wanted.
Check for rash - ? Meningococcal Septicaemia

Antibiotics - if infection cause suspected - IV, broad range

Question 4

What blood test would you expect to be raised in shock?

Answer 4

Lactate levels - due to anaerobic respiration of tissues

Question 5

What is anaphylactic shock?

Answer 5

A severe type 1 hypersensitivity reaction to a previously met antigen/allegen.

Question 6

What happens in anaphylaxsis?

Answer 6

Extreme response. Massive degranulation of mast cells, release of histamine, causes capillary leak and loss of vascular tone, can leave to systemic maldistributive shock.

Smooth muscle constricts - Bronchospasm

Question 7

What could you give to someone having an anaphylactic shock?

Answer 7

Adrenaline - IM, 0.5mg, 1 in 1000 strength. IV only iven by expereinces anaesthetists with specialised access.

Bronchodilators - salbutamol
Steroids
Antihistamines

Question 8

What are the different severities of sepsis?

Answer 8

SIRS - Systemic inflammatory response syndrome
Sepsis (SIRS + infection)
Severe Sepsis (Sepsis + hypoperfusion, low Bp of organ dysfunction)
Septic Shock ( Severe sepsis + refractory hypertension)
MODS (multiorgan dysfunction syndrome)

Question 9

What bacterial mediators initiate the sepsis cascade?

Answer 9

Gram -ve bacteria - endotoxins - eg LPPS - lipopolysaccharide
gram +ve bacteria - toxins - eg enterotooxin, peptiidoglycans

Question 10

When does a localised infection become systemic?

Answer 10

When the bacteria/infection gets into the bloodstream, where the immune cascade occurs and intravascular cytokine production leads to widespread endothelial injury.

Question 11

Why does widespread endoothelial injury cause damage?

Answer 11

It means the endothelium is leaky, there is increased dilation and permiablity - causing hypotension.

Question 12

What is the effect of sepsis on the CNS?

Answer 12

coma, confusion, encephalopathy

Question 13

What is the effect of sepsis on the CVS?

Answer 13

hypotension, capillary leak, reduced peripheral vascular resistance.

Question 14

What is the effect of sepsis on the Respiratory system?

Answer 14

ARDS - Acute respiratory distress syndrome.

Endothelium of alveolar capillaries are leaky - non cardiac oedema forms, causing reduced O2 uptake.

Question 15

What is the effect of sepsis on the GI tract?

Answer 15

Loss of mucosal integrity, bacteria can leak through into the blood.

Question 16

What is the effect of sepsis on the urinary system?

Answer 16

Kidney failure due to acute tubular necrosis

Anuria/oliiguria

Question 17

What is the effect of sepsis on haematology?

Answer 17

30% have thrombocytopaenia

DIC - disseminated intravascular coagulation - clotting and bleeding occurs at the same time.

Question 18

What is the effect of sepsis on endoocrine system?

Answer 18

Body is in a catabolic state - breaking things down
Increase in stress hormones
Steroid deficiency
deranged O2 metabolism

Question 19

How do vasodilators work?

Answer 19

They cause vascular smooth muscle relaxation

Question 20

How do arterial vasodilators work?

Answer 20

They cause a reduction in arterial vascular resistance - which reduces BP as BP = CO x SVR.

Question 21

How do venodilators work?

Answer 21

Reduce Bp by reducing caridac output by reducing stroke volume returning to the heart. Most volume is stored in veins - so relaxing veins increases stroage, so less returns. BP = (HR x SV) x SVR.

Question 22

Which type of vasodilator would you use in someone with heart failure?

Answer 22

Venodilator - as it reduces work load for heart by reducing stroke volume and cardiac output.

Question 23

What are the 2 main types of vascular constictors?

Answer 23

Catecholamines and non-catecholamines

Question 24

What is the synthetic catecholamine we use called?

Answer 24

Phenylephrine

Question 25

What are the non-catecholamines we use to increase Bp?

Answer 25

vasopressiin, angotensin.