SIRS/Sepsis ppt-josh Flashcards Preview

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Flashcards in SIRS/Sepsis ppt-josh Deck (37)
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1

WHO IS THE ONLY WHITE PERSON MIKE LIKES

 

Hippocrates

(prob b/c he's dead)

 

2

Sepsis is the 2nd leading cause of death in the non-coronary ICU pt's, dispite inproved care, mortality remains b/t __-__%

30-50%

3

what is the systemic inflammatory response to a wide variety of severe clinical insults

SIRS

4

SIRS:

is manifested by TWO or MORE of the following conditions!! what are those 4 conditions???

  1. Temp >38 C or < 36 C
  2. HR > 90 bpm
  3. RR > 20 bpm (or PaCO2 < 32)
  4. WBC- >12,000 or < 4,000 (or >10% bands)

basically is i walk to the mailbox i get SIRS

5

WHat is a systemic inflammatory response to an insult to a host, in association w/ infection.

Sepsis:

6

Sepsis:

what are the clinical manifestations for Sepsis:

same as for SIRS

7

Sepsis vs SIRS

is they manifest themselves the same how do you differentiate them?

Sepsis:- includes 2 or more of the mentioned conditions but 2ndary to a documented infection

8

Sepsis:

severe sepsis is associated w/ what 2 things?

 

Organ dysfunction

or hypotension

9

Severe Sepsis:

S/s

  • Hypoperfusion and perfusion abnormalities may include
  1. Lactic acidosis
  2. oliguria
  3. AMS

10

Sepsis:

What are examples of potent stimulus for activation of an inflammatory response (4)

  • trauma
  • Surgery
  • Organ dysfuntion
  • Infection w/ microorganisms or viruses

11

Sepsis:

SO what is the patho for this?

Endogenous sensing mechanisms initiate a response NOT specifically for the reconition of infection BUT rather in response to biochemicals that suggest imminent threat to host

 

12

Sepsis:

what are some of the biochemical markers

  • Cytolines
  • TNF-a
  • IL-1-6-8
  • PAF
  • Prostaglandins
  • Leukotrienes
  • Neutrophil
  • Complement system
  • Vascular endothelial cells
  • Clotting and kinin cascades
  • Thromboxane
  • prostacyclin
  • prostaglandin

13

Sepsis:

what is the effect that the biomarkers couse in the body

  • Vasodilation
  • Incrreased Capillary Permeability
  • Cellular activation
  • Coagulopathy

14

Sepsis/SIRS: Anesthesia management

what is the central treatment to sucessful treatment of a pt w/ severe sepsis

Srugical removal of impurity

early antimicrobial therapy

15

Sepsis/SIRS: Anesthesia management

in High-risk surgical or trauma pt's w/ sepsis, early ________ optimization before the development of organ failure reduced mortality by 23%

hemodynamic

16

SvO2:

what is it?

saturated venous oxygen

17

SvO2:

has an _____ relationship to oxygen utilization in fully saturated blood!

Inverse

(lower SvO2: is the more O2 used)

18

SvO2:

has a _____ relationship to CO and Hemoglobin

Direct

(one goes up the other goes up as well)

19

SvO2:

w/ constant O2 consumption, mixed venous O2 saturation demonstrates the balance b/t  what?

Oxygen delivery  and oxygen demand

20

SvO2:

SvO2 is the result of O2 consumption @ the ____ level!

Tissue

21

SvO2:

it is the result os O2 consumption at the tissue level. this is measured as the _________

Oxygen Extraction Ration ( O2ER)

22

SvO2:

What is the Normal O2ER value
 

24-28%

23

SvO2:

what is the Calculation for the O2ER?

O2ER = SaO2 - SvO2 / SaO2

  • SaO2 - Arterial O2 sat
  • SvO2 - mixed venous O2 sat

24

SvO2:

does a normal SvO2 alone show the status of specific organ perfusion

Nope

25

SvO2:

is SvO2 alone adequate representation of tissue perfusion in pt's w/ sepsis?

Again no fucking way

26

what is the "Golden Hours" of sepsis, and why is this important to us?

  • the first 6 hours of resuscitation in septic pt's
  • b/c this time usually coincide w/ the time for emergency sx

27

Sepsis/SIRS: Anesthesia management

Volume resuscitation using crystalloids or colloids should be used initially, aiming to to reach the following clinical endpoints... give the goal values

  1. CVP:
  2. MAP:
  3. UOP:
  4. Central Venous Oxygen saturation:

 

  1. 8-12 mmHg
  2. 65 mmHg
  3. 0.5 mL/kg
  4. 70%

28

Sepsis/SIRS: Anesthesia management

Vasopressor support w/ _______ may be considered even b4 optimal IV fluid loading has been achieved.

Norepinephrine

29

Sepsis/SIRS: Anesthesia management

low dose _____ may be subsequently added to Norepinephrine to reduce the requirement for high doses of Levophed

Vasopressin

30

Sepsis/SIRS: Anesthesia management

______ are added to volume resuscitation and vasopressors, if there is evidence of continued low CO despite adequate cardiac filling and fluid resuscitation

Inotropes