Flashcards in Sepsis -Goya Deck (20):
What is shock?
Failure to deliver oxygen and substrates to meet the metabolic demands of the tissue beds
supply < demand
oxygen delivery < oxygen consumption
What are the 4 types of shock?
Hypovolemic shock - ex: hemorrhage, volume depletion, interstitial fluid redistribution
Cardiogenic shock - due to heart failure --> pump failing--> fluid back into lungs --> hypoxemic
-* need to improve heart function
Extra-cardiac obstructive shock
(Obstructive) - external pressure on the heart impair heart contraction or filling (tension pneumo, PE, aortic dissection, tamponade)
Distributive shock - loss of vasomotor control --> dilation ==> shunt blood away from the system
What are the goals of treatment of shock?
decrease demand (treat hyperthermia, reduce work of breathing --> ventilation)
increase supply (improve preload (give fluid), improve contractility, dec after load, dec HR, improve O2)
treat the underlying cause
What is the #1 cause of mortality from MIs?
What determines the treatment of cardiogenic shock?
where the heart is affected
LV =bypass, stent, intraaortic balloon pump
fluid and inotropes with PA cath monitoring
What determines the acuity of the obstructive shock? What are the treatments for tampanade vs. PE?
Rate of development of the obstruction (how fast the shock occurred)
acute PE --> thrombolytic
What is the classic feature of distributive shock? What is an example of this?
(SIRS--> Septic shock)
What is SIRS? What is sepsis?
Systemic Inflammatory Response Syndrome (SIRS): 2 or more of the following:
T>38C or 90
RR>20 (or PaCO212K, 10%bands
sepsis: Confirmed or suspected *INFECTION* accompanied by SIRS
What is severe sepsis?
Presence of sepsis + organ hypoperfusion or dysfunction
Elevated lactic acid
Abnormal peripheral circulation
What is septic shock?
Presence of severe sepsis, plus refractory hypotension
SBP<65 or 40mmHg drop compared to baseline
Unresponsive to fluid challenge of 20-40ml/kg
Vasopressor dependency after adequate volume resuscitation
What is the first priority in any pt with severe sepsis or septic shock?
stabilization of airway and breathing
Can hypo perfusion occur in the absence of hypotension?
over time this will get worse and develop Hypotension
What are some signs of hypo-perfusion?
-Cool, vasoconstricted skin due redirection of blood flow to the core organs
-->Patients with early sepsis may have warm, flushed skin
-Obtundation or restlessness
-Oiguria or anuria
-Elevated Lactic acid level
*may have normal BP
SIRS criteria but cool and clammy and normal BP?
think pt may be going into septic shock
Why is crystalloid or colloid fluid given to sepsis pts?
get the CVP > 12 mmHg
When should antibiotics be given for sepsis? What type of antibiotic?
Broad-spectrum antibiotic within 1 hour recognition septic shock.
Blood cultures before antibiotics --> can adjust meds based on culture results
What is the drug of choice for septic pt with hypotension?
norepinephrine (or epinephrine if NE doesn't work)
only use dobutamine with low CO
What are the signs to look for to determine adequacy of resuscitation?
Capillary refill < 2 sec
Normal mental status
Urine output > 1 mL/kg/hr
Adequate blood pressure
Improved base deficit
SvO2 > 70%
A 45-year-old man with acute cholecystitis is noted to have a fever of 38.3°C (101°F), hypotension, and altered sensorium. His hematocrit is noted to be 24%. Broad-spectrum antibiotics and intravenous saline are administered, and, although his Central Venous Pressure is 10 and his Mean Arterial Pressure is 80, his Scvo2 (mixed venous o2) remains
D. RBC Transfusion
hematocrit is 24--> super anemic --> give blood first
if hematocrit was higher, dobutamine would have been a good answer