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Small Animal Medicine II > Sepsis > Flashcards

Sepsis Flashcards

1
Q

What is necrotizing fasciitis?

A

Flesh eating bacteria!

Not common in vet med however in dogs the agent is Streptococcus canis

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2
Q

Definition of sepsis

A

Infection + organ dysfunction

Dysregulated host response to infection

Presence of an infectious etiology and the presence of clinical signs (indicating systemic involvement)

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3
Q

Approach to sepsis

A

Individualized!

Each patient is different; there is no cook-book solution

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4
Q

What is included in a SOFA score (3 things)

A

Hypotension
Altered mental status
Tachypnea

Note: can also do bloodwork to look at arterial blood gas, BUN, lactate, bilirubin, platelet count

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5
Q

Definition of septic shock

A

Hypotension requiring vasopressors to regulate/maintain adequate blood pressure

Vasopressor example: norepinephrine

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6
Q

Old definition of sepsis and why it is not used anymore

A

Sepsis = infection + SIRS (Systemic Inflammatory Response Syndrome)

SIRS is too broad

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7
Q

SIRS Criteria (4 things)

A

Tachycardia
Tachypnea
Hypo or hyperthermic
Leukocytosis or leukopenia

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8
Q

What is MODS?

A

Multiple Organ Dysfunction Syndrome

Physiologic derangements of the endothelial cardiopulmonary, renal, nervous, endocrine, and/or GI systems

Once this starts occuring in a patient, most likely have reached the point of no return (MODS + SIRS + DIC)

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9
Q

Common causes of sepsis in dogs

A

Diabetes
Hypoadrenalcorticism
GI Tract
Respiratory Tract

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10
Q

Common causes of sepsis in cats

A

FIP
FeLV
CKD
Cholangitis

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11
Q

Diagnosis of sepsis (5 things)

A 
Fever/hypothermia (cats)
Tachycardia/Bradycardia (cats)
Altered mental status
Edema or positive fluid balance
Hyperglycemia (cats initially)/Hypoglycemia
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12
Q

Cat lethal triad

A

Hypothermic
Hypotensive
Bradycardic

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13
Q

Early Septic Shock

Dog

A 
Tachycardia
Tachypnea
Hyperemia
Decreased CRT
Pyrexia

Warm phase

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14
Q

Early Septic Shock

Cat

A 
Lethargic
Bradycardic
Hypothermic
Pale mucous membranes
Weak pulses
Hypotensive
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15
Q

Early Decompensated Sepsis

Clinical Signs

A 
Sympathetic system not compensating
Pale mm  
Poor pulse quality
Hypotension
Hypoperfusion
Mental depression
Hyperlactaemia 
Endothelial dysfunction
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16
Q

Late Decompensated Septic Shock

Clinical Signs

A

Hypothermia
Stuporous/comatose
Pale mm, no CRT
Poor pulse quality

17
Q

MODS

Examples

A

AKI
Respiratory failure
Loss of vasomotor tone
Cardiac impairment

18
Q

What is hemostasis?

A

Balance between pro-coagulation and anticoagulation

Maintain blood free of clots but allow clots to form when needed

Endothelium is responsible for this

19
Q

Organ dysfunction:

Cardiovascular

A

Increased permeability of vasculature

Impaired cardiac contractility

Loss of vascular tone

20
Q

Where does fluid leak?

A

Abdomen, tibiotarsal joint, SQ space

Cats: chest, pulmonary effusion

21
Q

Organ Dysfunction:

Respiratory

A

Endothelial and epithelial injury

Accumulation of protein rich fluid in the alveoli

Decreased microvascular perfusion

Acute lung injury (ALI)
Acute Respiratory Distress Syndrome (ARDS)

22
Q

Organ Dysfunction:

Renal

A

Acute tubular necrosis secondary to renal ischemia

Tissue injury may be due to ischemia-reperfusion injury

Kidneys need high blood flow (receive 20% of CO)

Look for decreased urine production

23
Q

Organ Dysfunction:

Neurological

A

Poorly understood

Reduction of cerebral blood flow

Capillary leakage and damage of the blood brain barrier

24
Q

Organ Dysfunction:

GI

A

Ileus, poor tolerance to enteral feeding, vomiting, diarrhea, GI ulceration, melena, hematochezia

May need liquid diet with prokinetic

25
Q

Organ Dysfunction:

Hepatic

A 
Hypoalbuminemia
Coagulopathies
Hypoglycemia 
Icterus
Mental depression 
Encephalopathies
26
Q

Organ Dysfunction:

Endothelium

A

Increased vascular permeability

Decreased vascular tone due to endothelial dysfunction

Rx: now trying Vitamin C

27
Q

Diagnosis of Sepsis

CBC

A

Leukocytosis (bands-left shift, toxic neutrophils, degenerative neutrophils)

Anemia (especially in cats)

Thrombocytopenia (consumption, sequestration)

Activation of hemostasis (hypercoagulable then hypocoagulable)

28
Q

Diagnosis of Sepsis

Chemistry

A

Hyperbilirubinemia

Hyperglycemia followed by hypoglycemia

Hypoalbuminemia

Other evidence of organ failure (MODS)

Note: liver is a sympathetic organ, sensitive to hypoxia

29
Q

How to treat Sepsis

3 classes of drugs

A

Treat ASAP

Antibiotics
Vasopressors
Ionotropes

30
Q

How to treat Sepsis

Antibiotics

A

First submit samples for culture and sensitivity

Empiric broad spectrum/4-quadrant to start then wean off when tests return (want to avoid resistance)

31
Q

How to treat Sepsis

Vasopressors

A 
Epinephrine (bradycardic and decreased systolic function) 
Norepinephrine
Dopamine
Vasopressin
Phenylphrine
32
Q

How to treat Sepsis

Ionotropes

A

Dobutamine (helps with cardiac contractility)

33
Q

How to treat Sepsis

Other Rx Considerations

A

Glucocorticoids; physiologic dose may be okay, assists with vascular response to vasopressors
Critical illness-related corticosteroid insufficiency (adrenal insufficiency)

Vitamin C to help endothelium (work still being done)

Small Animal Medicine II (17 decks)

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