SIRS/Sepsis ppt-josh Flashcards Preview

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

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?

filling pressures are high

and no further improvements in tissue perfusion is seen

32

Sepsis/SIRS: Anesthesia management

what happens to MAC in severe sepsis

Decreased

33

Sepsis/SIRS: Anesthesia management

the goal of mechanically ventilating pt's w/ severe sepsis is to use ____ FiO2 concentrations

High

34

Sepsis/SIRS: Anesthesia management

there is evidence supporting the use of Low tidal volume ventilation, why is ths benificial

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

35

Sepsis/SIRS: Anesthesia management

oxygenation may be impaired by non-cardiogeic pulmonary edema, which is caused by what?

Increaased capillary permeability

36

Sepsis/SIRS: Anesthesia management

Management options for hypoxemia during anesthesia include what tech

  • Increasing Fio2
  • Increasing PEEP

37

Thank you nigger

i mean mike... no i mean nigger