Treatment of Sepsis Flashcards
(32 cards)
What are the mainstays of treatment of sepsis?
- early aggressive CV resuscitation– O2, fluids, pressors, ionotropes, packed RBCs
- laminitis prevention
- removal of the cause of sepsis
- Neutralization of circulating endotoxin & other pAMPs
- inhibition of PAMP induced inflammation
What is the dose of plasma administration for sepsis?
20-40 ml/kg
What is the goal of plasma administration in sepsis/endotoxemia?
replace extravasated colloid from vascular leak
What are the advantages of plasma administration for sepsis/endotoxemia?
immunoglobulin
acute phas proteins
anti-coagulants
antiendotoxin Ab
What is the fluid bolus rate? and how often repeated?
20 ml /kg, then continue at 10-20 ml/kg for a total of 60-80 ml/kg
If no improvement with intravenous fluid boluses, then what can be administered to improve cardiovascular function?
colloids
inotropes
vasopressors
When should bicarb be supplemented?
<16 mmol/L
**post fluid restoration
During acidemia correction, what electrolyte should you supplement for?
potassium (10-20 mmol/L) to prevent hypokalemia
What pathogenic mechanisms of sepsis/endotoxemia lead to the development of laminitis?
- insulin resistance
- hyperlgycemia
- microvascular injury & thrombosis
- protease activation
What are prophylactic treatments to administer prior to appreciating an increase in digital pulses associated endotoxemia/sepsis, for the prevention of laminitis?
prompt fluid resuscitation
NSAIDs (dec inflamm mediators)
digital cryotherapy
During an intestinal strangulation, with return of intesinal blood flow could worsen endotoxemia & sepsis because:
- sequestered endotoxin flushed into circulation
- ischemia/reperfusion injury
What can be administered intraop/prophylatically before undoing an intesinal strangulation?
NSAIDs
ROS scavengers
Polymixin B
hyperimmuen plasma/serum
What medications can be administered to neutralize circulating endotoxin?
hyperimmune plasma & serum
polymixin B
What is the dose of polymixin B?
1,000 to 6,000 U/kg q8h
**dilute in saline and give over 15 minutes
What NSAIDs can be given to inhibit endotoxin induced inflammation & related sequlae through COX inhibition?
flunixin meglumine, phenylbutazone
ketoprofen, carprofen
meloxicam, firocoxib
aspirin
What are negative side effects of COX-1 and COX-2 inhibition?
gastric ulceration
R dorsal colitis
renal papillary necrosis
DEC intestinal motility
Methylxanthine derivatives inhibit endotoxin induced inflammation & related sequelae through what mechanism?
suppress macro cytokine production via
phosphodiesterase inhitino
**INC intracellular cyclic adnosine monophosphate**
What is an example of a methylxanthine derivative?
Pentoxyfylline
What are the mechanisms that Pentoxyfylline inhibits endotoxin induced inflammation & related sequelae?
inhibits TNF alpha production
INC secretion of prostacyclin
Dose of Pentoxyfylline
10 mg/kg PO q12h
Corticosteroids inhibit endotoxin induced inflammation through what mechanisms?
dec cytokine production
stabilize cell membranes prevent neutrophil activation
What can corticosteroids induce laminitis in septic horses?
- INC sensitivity of digital vessels to constrictive effects of catecholamines
- Inducing insulin resistance & hyperglycemia
What anticoagulant therapies may be indicated in tx of colitis/endotoxemia?
- heparin
- clopidigrel
- aspirin
By what mechanism does unfractioned heparin beneficial as an anticoagulant in tx of sepsis/endotoxemia?
prevents microvascular thrombosis via AT-III
**cannot reverse existing thrombosis
