SIRS/Sepsis ppt-josh

Question 1

WHO IS THE ONLY WHITE PERSON MIKE LIKES

Answer 1

Hippocrates

(prob b/c he’s dead)

Question 2

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

Answer 2

30-50%

Question 3

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

Answer 3

SIRS

Question 4

SIRS:

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

Answer 4

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

Question 5

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

Answer 5

Sepsis:

Question 6

Sepsis:

what are the clinical manifestations for Sepsis:

Answer 6

same as for SIRS

Question 7

Sepsis vs SIRS

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

Answer 7

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

Question 8

Sepsis:

severe sepsis is associated w/ what 2 things?

Answer 8

Organ dysfunction

or hypotension

Question 9

Severe Sepsis:

S/s

Answer 9

• Hypoperfusion and perfusion abnormalities may include

1. Lactic acidosis
2. oliguria
3. AMS

Question 10

Sepsis:

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

Answer 10

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

Question 11

Sepsis:

SO what is the patho for this?

Answer 11

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

Question 12

Sepsis:

what are some of the biochemical markers

Answer 12

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

Question 13

Sepsis:

what is the effect that the biomarkers couse in the body

Answer 13

• Vasodilation
• Incrreased Capillary Permeability
• Cellular activation
• Coagulopathy

Question 14

Sepsis/SIRS: Anesthesia management

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

Answer 14

Srugical removal of impurity

early antimicrobial therapy

Question 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%

Answer 15

hemodynamic

Question 16

SvO₂:

what is it?

Answer 16

saturated venous oxygen

Question 17

SvO2:

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

Answer 17

Inverse

(lower SvO2: is the more O2 used)

Question 18

SvO2:

has a _____ relationship to CO and Hemoglobin

Answer 18

Direct

(one goes up the other goes up as well)

Question 19

SvO2:

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

Answer 19

Oxygen delivery and oxygen demand

Question 20

SvO2:

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

Answer 20

Tissue

Question 21

SvO2:

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

Answer 21

Oxygen Extraction Ration ( O2ER)

Question 22

SvO2:

What is the Normal O2ER value

Answer 22

24-28%

Question 23

SvO2:

what is the Calculation for the O2ER?

Answer 23

O2ER = SaO₂ - SvO₂ / SaO₂

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

Question 24

SvO2:

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

Answer 24

Nope

Question 25

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

Answer 25

Again no fucking way

Question 26

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

Answer 26

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

Question 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:

Answer 27

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

Question 28

Sepsis/SIRS: Anesthesia management Vasopressor support w/ _______ may be considered even b4 optimal IV fluid loading has been achieved.

Answer 28

Norepinephrine

Question 29

Sepsis/SIRS: Anesthesia management low dose _____ may be subsequently added to Norepinephrine to reduce the requirement for high doses of Levophed

Answer 29

Vasopressin

Question 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

Answer 30

Inotropes

Question 31

Sepsis/SIRS: Anesthesia management Resuscitation efforts should be continued as long as hemodynamic improvement accompies each step in the process, Further IV fluid administration shoul dbe stopped when?

Answer 31

filling pressures are high and no further improvements in tissue perfusion is seen

Question 32

Sepsis/SIRS: Anesthesia management what happens to MAC in severe sepsis

Answer 32

Decreased

Question 33

Sepsis/SIRS: Anesthesia management the goal of mechanically ventilating pt's w/ severe sepsis is to use ____ FiO2 concentrations

Answer 33

High

Question 34

Sepsis/SIRS: Anesthesia management there is evidence supporting the use of Low tidal volume ventilation, why is ths benificial

Answer 34

* Minimize the impact of positive pressure ventilation on lung tisuue * minimize effcts on venous return and CO

Question 35

Sepsis/SIRS: Anesthesia management oxygenation may be impaired by non-cardiogeic pulmonary edema, which is caused by what?

Answer 35

Increaased capillary permeability

Question 36

Sepsis/SIRS: Anesthesia management Management options for hypoxemia during anesthesia include what tech

Answer 36

* Increasing Fio2 * Increasing PEEP

Question 37

Thank you nigger

Answer 37

i mean mike... no i mean nigger