Septic shock

Question 1

Describe : Sepsis

Answer 1

A life-threatening condition characterized by organ dysfunction due to a
dysregulated immune or inflammatory response to infection.

Question 2

Describe : SEPTIC SHOCK

Answer 2

• Sepsis-induced hypotension (such as a mean arterial pressure [MAP] below 65 mm Hg) and cellular/metabolic abnormalities despite adequate IV fluids.
• patients who after adequate volume resuscitation have persistent hypotension requiring vasopressors to maintain MAP greater than or equal to 65 mm Hg and also have a lactate greater than or equal to 2 mmol/L.

Question 3

Name : LABORATORY VALUES CONCERNING FOR SEPSIS (10)

Answer 3

• Leukocytosis (greater than 12,000/mcL) or leukopenia (less than 4000/mcL)
• Hyperglycemia (glucose greater than 140 mg/dL) in patients without diabetes
• Elevated lactate (greater than 2 mmol/L)
• Hypoxemia with PaO,/FiO, less than 300
• Acute oliguria (urine output less than 0.5 mL/kg/h after adequate fluid resuscitation)
• Creatinine increase of more than 0.5 mg/dL from baseline
• Thrombocytopenia with platelets less than 100,000/mcL
• Hyperbilirubinemia with total bilirubin greater than 4 mg/dL
• C-reactive protein greater than 2 standard deviations above upper limits of normal value
• Procalcitonin greater than 2 standard deviations above upper limits of normal value is associated with bacterial infections and sepsis

Question 4

Name : Signs of end-organ hypoperfusion include
the following (5)

Answer 4

• Decreased capillary refill, cyanosis, or mottling
• Cool, clammy skin
• Altered mental status, obtundation, or restlessness
• Decrease in urine output
• Decreased bowel sounds

Question 5

Describe : International Guidelines for Management of Sepsis and Septiv Shock

Answer 5

• 1. Measure lactate: Re-measure if initial lactate is greater than 2 mmol/L (usually in 2-3 hours).
• 2. Obtain **blood cultures **prior to the administration of antibiotics.
• 3. Administer broad-spectrum parenteral antibiotics.
• 4. Begin rapid administration of 30 mL./kg crystalloid for patients with hypotension or a lactate of 4 mmol/L or greater.
• 5. Apply vasopressors to maintain a** MAP of 65 mm Hg or greater.**

Question 6

Empiric parenteral broad-spectrum therapy should cover what? (4)

Answer 6

• likely pathogens and be chosen based on local resistance patterns
• Fungal or viral coverage should be included for patients with known risk factors (such as immunocompromised patients or those with known colonization of specific pathogens).
• Once an organism is identified, the antimicrobial therapy should be narrowed to reduce the risk of resistant organisms.
• Most patients have a therapy duration of 7-10 days.

Question 8

Name ATB selection recommendations if : Sepsis, source unclear (3)

Answer 8

• Pip/tazo
• or a carbapenem + vancomycin
• Consider adding antifungal if clinically relevant (eg, severe immunosuppression)

Question 9

The diagnostic criteria for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) include what? (4)

Answer 9

• (1) acute onset
• (2) presence of bilateral infiltrates on chest radiography consistent with pulmonary edema
• (3) pulmonary artery wedge pressure less than 18 mm Hg or clinical absence of left atrial hypertension, and
• (4) hypoxemia with PaO/FiO, less than or equal to 300 mm Hg for ALl or less than or equal to 200 mm Hg for ARDS.

Question 10

What’s the target blood glucose level?

Answer 10

• The optimal blood glucose range has been controversial.
• Most clinicians target blood glucose levels between **140 and 180 mg/dL (7.7 to 10 mmol/L). **
• Surviving Sepsis guidelines recommend less than 180 mg/dL.

Question 11

Describe : Disseminated Intravascular Coagulation

Answer 11

• a syndrome characterized by a systemic activation of coagulation leading to the intravascular deposition of fibrin in the microvasculature and the simultaneous consumption of coagulation factors and platelets.
• Physical examination signs may reveal petechia, ecchymosis, gangrene, mental disorientation, hypoxia, hypotension, and gastrointestinal bleeding.

Question 12

Describe diagnosis : Disseminated Intravascular Coagulation (4)

Answer 12

diagnosis is established by abnormalities in coagulation tests
* including decreased platelet count
* increased prothrombin time
* elevated fibrin-related markers (D-dimer/fibrin degradation)
* and decreased fibrinogen level.