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rx555 - id3 > Sepsis and Septic Shock > Flashcards

Sepsis and Septic Shock Flashcards

1
Q

Sepsis-3 Definition (2016)

A

Life-threatening organ dysfunction caused by a dysregulated host response to infection

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2
Q

Septic Shock
(Distributive shock)

A

Subset of sepsis in which profound circulatory, cellular, and metabolic abnormalities are associated with a great risk of mortality
Need for vasopressor to maintain mean arterial pressure (MAP) ≥65 mmHg despite adequate fluid resuscitation
Lactate >2 mmol/L

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3
Q

Fluid Resuscitation

A

Provide fluid therapy to increase intravascular volume and venous return
Crystalloids
Dynamic

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4
Q

Fluid Resuscitation - Amount of fluid

A

30 mL/kg within the first 3 hours of resuscitation

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5
Q

Fluid Resuscitation - Type of Fluid

A

First-line fluid for resuscitation = Crystalloids

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6
Q

When to use albumin for fluid resuscitation?

A

Patients who already received a significant amount of crystalloids and at risk of volume overload

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7
Q

Which crystalloid is suggested and why?

A

balanced crystalloids (lactated ringers)
Concern for normal saline and its potential harm related to hyperchloremic metabolic acidosis leading to renal failure

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8
Q

Fluid Resuscitation - Assessment of Fluid Responsiveness

A

Passive leg raise - Allowing the blood from the legs to act as a fluid bolus back to the heart

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9
Q

MAP

A

Mean Arterial Pressure
MAP ≥65 mmHg is needed for adequate perfusion
MAP = 1/3 SBP + 2/3 DBP

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10
Q

Lactate

A

Blood Lactate
Metabolic product of anaerobic metabolism
Biomarker for global tissue hypoxia
Lactate > 2 mmol/L: global hypoperfusion

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11
Q

Initial management of sepsis and septic shock

A

Surviving Sepsis Campaign (SSC) Hour-1 Bundle
Measure lactate level (Re-measure if initial lactate >2 mmol/L)
Obtain blood and other relevant cultures
Administer broad-spectrum antibiotics
Rapidly administer 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L
Start vasopressors if hypotensive during or after fluid resuscitation to maintain mean arterial pressure (MAP) ≥ 65 mmHg

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12
Q

Alpha-1 (α1) Tissue

A

Vascular smooth muscle

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13
Q

Alpha-1 (α1) Stimulation of Receptor

A

Vasoconstriction

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14
Q

Beta-1 (ꞵ1) Tissue

A

Heart

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15
Q

Beta-2 (ꞵ2) Tissue

A

Bronchial smooth muscle
Vascular smooth muscle

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16
Q

Vasopressin-1 (V1) Tissue

A

Vascular smooth muscle

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17
Q

Vasopressin-2 (V2) Tissue

A

Kidneys

18
Q

Angiotensin-1 (AT-1) Tissue

A

Vascular smooth muscle
Kidneys

19
Q

Beta-1 (ꞵ1) Stimulation of Receptor

A

Increased HR and contractility

20
Q

Beta-2 (ꞵ2) Stimulation of Receptor

A

Bronchodilation
Vasodilation

21
Q

Vasopressin-1 (V1) Stimulation of Receptor

A

Vasoconstriction

22
Q

Vasopressin-2 (V2) Stimulation of Receptor

A

Fluid retention

23
Q

Angiotensin-1 (AT-1) Stimulation of Receptor

A

Vasoconstriction
Fluid and sodium retention

24
Q

Norepinephrine Receptors

A

α1, ꞵ1

25
Q

First line Vasopressor

A

Norepinephrine

26
Q

Epinephrine Receptors

A

α1, ꞵ1, ꞵ2

27
Q

First alternative or an add-on to norepinephrine

A

Epinephrine

28
Q

Epinephrine adverse effects

A

Tachyarrhythmias (beta-1 stimulation)
Lactic acidosis (beta-2 stimulation)
Hyperglycemia (beta-2 stimulation)

29
Q

Dopamine Receptors

A

Dose-dependent activity
Low dose (1-3 mcg/kg/min): DA
Medium dose (3-10 mcg/kg/min): ꞵ1
High dose (10-20 mcg/kg/min): α1, ꞵ1

30
Q

Dopamine place in therapy

A

Not preferred (risk of arrhythmias)

31
Q

Phenylephrine Receptors

A

α1

32
Q

Phenylephrine place in therapy

A

In select patients who may not tolerate other vasopressors (e.g. tachyarrhythmia on norepinephrine)
Mostly used as salvage therapy

33
Q

Vasopressin receptors

A

V1, V2

34
Q

Vasopressin place in therapy

A

Add-on to norepinephrine
To further increase MAP to target
To decrease norepinephrine requirements

35
Q

Angiotensin II

A

AT-1, AT-2

36
Q

Angiotension II place in therapy

A

Unclear; Reserved for only select patients
Approved indication: septic/distributive shock

37
Q

Vasopressin Efficacy Monitoring Parameters

A

Mean arterial pressure (MAP)
Heart rate (HR)
Infusion rates
Resolution of shock (signs and symptoms)

38
Q

Vasopressin Safety Monitoring Parameters

A

Line access (central vs. peripheral)
Extravasation (antidote: phentolamine)
Peripheral vasoconstriction
Electrocardiogram (ECG) and telemetry
Adverse events associated with each vasopressor

39
Q

Vasopressin Adjunct therapies

A

Corticosteroids
Hydrocortisone 50 mg IV Q6H
For septic shock not responsive to fluid resuscitation and increasing vasopressors

IV Vitamin C
Not Recommended

40
Q

Supportive Care

A

VTE Prophylaxis
Stress Ulcer Prophylaxis
Glucose Management
Nutrition Support
(Maybe add more or separate here)

rx555 - id3 (13 decks)

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