Septicemia

Question 1

Septicemia

Answer 1

presence of pathogens and toxins in blood

Question 2

Bacteremia

Answer 2

presence of bacteria and toxins in the blood

Question 3

sepsis

Answer 3

whole body inflammation caused by infection

Question 4

SIRS Criteria

Answer 4

(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

Question 5

SIRS

Answer 5

Systemic Inflammatory Response Syndrome

• a systemic inflammatory response
• typically an immune response to infection but not always

Question 6

MEWS and PEWS

Answer 6

• modified early warning system
• pediatric early warning signs
• like SIRS criteria but may include more/fewer signs

Question 7

Sepsis is the result of…

Answer 7

an infection

Question 8

With sepsis, the infection is…

Answer 8

uncontrolled or spreads and releases bacteria or toxins into the blood

• this triggers the systemic inflammatory response
• sepsis is SIRS caused by an infection

Question 9

Sepsis is ____ caused by an infection

Answer 9

SIRS

Question 10

Cascade of Sepsis

Answer 10

• 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

Question 11

Severe Sepsis

Answer 11

• if sepsis is not controlled it enters what we call severe sepsis
• this is sepsis with one organ system damaged or experiencing failure

Question 12

DIC

Answer 12

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

Question 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?

Answer 13

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

Question 14

DIC Tx

Answer 14

• 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

Question 15

What is shock?

Answer 15

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

Question 16

Septic Shock

Answer 16

• 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

Question 17

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

Answer 17

• decreased tissue perfusion
• hypotension
• microvascular occlusion (DIC)

Question 18

Compensatory Shock

Answer 18

• 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

Question 19

Progressive Shock

Answer 19

• 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

Question 20

Refractory Shock

Answer 20

• 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

Question 21

Early signs of Septicemia

Answer 21

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

Question 22

Late signs of Septicemia

Answer 22

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

Question 23

Initial tx

Answer 23

• 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

Question 24

Albumin

Answer 24

• 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

Question 25

if EGDT is unsuccessful...

Answer 25

- 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

Question 26

Normal Lactate levels

Answer 26

0.5-2.0

Question 27

Lactate

Answer 27

product of cellular metabolism that can accumulate when cells lack O2