Flashcards in Test #2 Sepsis ARTICLES - Rude man Deck (19)
presence of bacteria in the bloodstream
the presence of large numbers of baceria in the bloodstream often associated with systemic signs and symptoms such as fever, rigors, and headache
Define systemic inflammatory response syndrome (SIRS).
the threshold definition is two or more of the following:
- temp > 38 C or < 36 C
- HR > 90
- RR > 20 or PaCO2 < 32
- WBC < 4 or > 12 or > 10% immature forms
SIRS with clinical evidence of infection
Define severe sepsis.
sepsis associated with organ dysfunction, hypotension, or hypoperfusion abnormalities
Define septic shock.
sepsis-induced hypotension, despite fluid resuscitation, plus hypoperfusion abnormalities
Define sepsis-induced hypotension.
a systolic arterial pressure < 90mmHg or a reduction of > 40mmHg from baseline in the absence of other causes for hypotension
In high-risk surgical or trauma patients with sepsis, early hemodynamic optimization before the development of organ failure reduced mortality by _____ % in comparison with those who were optimized after the development of organ failure.
After the diagnosis of severe sepsis or septic shock is made, should you wait for cultures to come back before you start antibiotics?
no, IV antibiotics should be started as early as possible.
broad-spectrum agents should be used initially with one or more agents active against all likely bacterial/fungal pathogens.
The first 6 hours of resuscitation of septic patients are called the _______ _______.
golden showers... i mean, hours
When volume resuscitating a hypotensive septic patient with crystalloids or colloids, what clinical endpoints do you aim for? (4)
- CVP 8-12 mmHg
- MAP 65 mmHg
- UOP 0.5 mL/kg
- SvO2 >70%
What is the first line inotrope therapy to be added to vasopressor in a septic patient?
When should fluid administration be stopped?
when filling pressures are high and no further improvement is seen in tissue perfusion (eg. serum lactate isn't decreasing)
Since these patients are in an inherently unstable cardiovascular state, how would you go about doing induction of anesthesia? (kind of a vague question, i know)
in a deliberate step-wise process, using small doses of IV anesthetic agents, titrated to clinical response
Is MAC increased or decreased in severe sepsis?
(if the patient has significant lung dysfunction, it's better to use IV agents instead of inhalation agents)
What two lab values would indicate adequacy of global oxygen delivery?
- serum lactate < 2
- mixed venous O2 sat > 70%
Hypercarbia should be avoided specifically in these patients. (3)
- raised ICP
- compensated metabolic acidosis
- someone in the later stages of pregnancy
What is the term for the difference between the pressure inside and outside the alveolar air space at end-inspiration?
(when an end-inspiratory pause has been applied, it is an indicator of the maximal pressure applied inside the alveolar sac)