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Flashcards in Septicemia Deck (27)
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1

Septicemia

presence of pathogens and toxins in blood

2

Bacteremia

presence of bacteria and toxins in the blood

3

sepsis

whole body inflammation caused by infection

4

SIRS Criteria

(any two)

-temp greater than100.4 or less than 95.0
-RR greater than 22 or PaCO2 less than 32
-HR greater than 90
-WBC greater than 12,000 or less than 4,000

5

SIRS

Systemic Inflammatory Response Syndrome

-a systemic inflammatory response

-typically an immune response to infection but not always

6

MEWS and PEWS

-modified early warning system

-pediatric early warning signs

-like SIRS criteria but may include more/fewer signs

7

Sepsis is the result of...

an infection

8

With sepsis, the infection is...

uncontrolled or spreads and releases bacteria or toxins into the blood

-this triggers the systemic inflammatory response

-sepsis is SIRS caused by an infection

9

Sepsis is ____ caused by an infection

SIRS

10

Cascade of Sepsis

-when inflammatory response becomes exaggerated, inflammation, and coagulation increase

-leads to microthrombi and obstruction of capillaries

-endothelial (vein/arterial wall) damage, vasodilation, and increased capillary permeability

11

Severe Sepsis

-if sepsis is not controlled it enters what we call severe sepsis

-this is sepsis with one organ system damaged or experiencing failure

12

DIC

Disseminated Intravascular Coagulation

-widespread activation of clotting which causes clots in small blood vessels

-leads to a drop in tissue perfusion which can lead to tissue and organ damage, failure

-sepsis is one of the leading causes of DIC

13

Even though DIC is characterized by excessive clotting in the intravascular space, the patient is actually at a very high risk for bleeding. Why do you think that is?

increased clotting depletes the platelets and clotting factors needed to control bleeding, causing excessive bleeding.

14

DIC Tx

-monior VS, clotting factors

-S/S of hemorrhage, bleeding

-Fix hypovolemia

-Possibly platelet transfusions

-possibly heparin, especially prophylactly when DIC is slowly evolving. Not when it is quick

15

What is shock?

-generally it is when there is insufficient blood flow to meets the body's demands (lack of perfusion)

16

Septic Shock

-severe sepsis with persistent hypotension which is unresponsive to fluid replacement therapy and organ system damage and/or failure to 2 or more organ systems.

-MODS (multiple organ dysfunction syndrome)

-very high mortality rate

17

Organ systems because damaged during septic shock as a result of...

-decreased tissue perfusion

-hypotension

-microvascular occlusion (DIC)

18

Compensatory Shock

-Stage 1

-Baroreceptors detect drop in MAP

-SNS kicks in, ups HR, and cardiac contraction

-Peripheral vasoconstriction

-Perfusion of systems is maintained due to this

-Signs are nearly imperceptible

19

Progressive Shock

-Stage 2

-Sustained drop in MAP

-Compensatory mechanisms from stage 1 are still active, but unable to keep MAP up

-Vasoconstriction actually starts to limit blood flow

-lactic acid builds up causing acidosis

-sodium-potassium pump of cells fails, leads to loss of intracellular K, Na, and water move in

-cells swell up from Na and water, causes organelle damage

20

Refractory Shock

-Stage 3

-Tissue damage and lack of O2 become so widespread that tissues and organs fail and die

-Even if MAP is restored, damage has become too widespread to prevent organ death

21

Early signs of Septicemia

-Hypotension
-rapid, thready pulse
-quick, deep respirations
-warm, flushed skin
-alert and oriented x3
-normal urine output
-elevated temp

22

Late signs of Septicemia

-hypotension
-Tachycardia, possible arrhythmias
-rapid, shallow respirations, dyspnea
-cool, pale, edematous
-lethargic, possible comatose
-oliguria or anuria
-decreased temp

23

Initial tx

-will be early goal directed resuscitation therapy

-fluid challenge of 30mL/kg of crystalloid solution (NS, D51/2, LR)

-vasopressors (vasopressin, dopamine, norepi)

-goal is to raise MAP, HR, urine output more than 0.5mL/kg/hr

24

Albumin

-may see albumin admin along with crystalloid IVFs

-idea is that albumin acts as an anti-inflammatory and anti-oxidant and helps maintain plasma osmolarity

-however, benefits compared to only admin crystalloid IVFs are virtually non existent and there is a risk of complications when admin albumin

25

if EGDT is unsuccessful...

-admin to ICU likely

-antibiotics to tx infection

-resuscitation via O2, maintaining airway, possible mech ventilation in shock

-RBC/platelet transfusion

-external cooling or heating

-nutritional support, shock pts generally lack sufficient protein

-vasopressors for hypotension

-monitor lactate levels

26

Normal Lactate levels

0.5-2.0

27

Lactate

product of cellular metabolism that can accumulate when cells lack O2