Week 7 - Sepsis Flashcards
Diagnostic markers (5)
Need at least 2:
- Temp > 38.3
- WBC < 4,000 or > 12,000
- HR > 90
- > 10% bands
- RR > 20
Most common lung cause
Pneumonia
Most common GU cause
UTI
Severe sepsis defintion
Presence of acute organ dysfunction
Severe sepsis s/s (9)
- thrombocytopenia, coagulopathy
- AMS
- oliguria, AKI
- respiratory failure
- hypotension, hypoperfusion
- lactate > 4
Septic shock definition
Hemodynamic instability despite fluid challenge
Septic shock s/s (3)
- SBP < 90 (or 40 below baseline)
- MAP < 65 after 30 mL/kg fluid bolus over 30 min
- multi organ dysfunction
3 hour bundle (4)
- measure lactate
- IV broad spectrum Abx
- 30 mL/kg crystalloid
- MAP goal > 65
6 hr bundle (3)
- vasopressors for MAP 65 or higher
- CVP, SvO2
- Re-measure lactate
First choice of vasopressor for sepsis
Norepinephrine
In sepsis would you be hyper or hypoglycemic?
Hyperglyecmic
MT complications (7)
- reaction
- coagulopathy
- hypocalcemia
- hypomagensemia
- hypokalemia
- hypothermia
- metabolic acidosis
Why does dilutional coagulopathy occur in a MT?
- Trauma –> DIC
- Hemorrhagic shock –> fluid shift from interstitial to intravascular –> dilution of coagulation factors
- But the PRBCs you’re giving don’t have platelets or clotting factors (coagulation factor deficient)
Why does hypocalcemia occur in a MT?
- Citrate (an anticoag) in PRBCs binds with Ca –> lowers ionized level
S/s of hypocalcemia
- Tetany like manifestations
- Myocardial depression
Hypomagnesemia
- Citrate binds with Mg too
S/s of hypomagnesemia
Dysrthythmias
Why does hyperkalemia occur in a MT?
- As blood ages –> hemolysis occurs –> blood contains more K+
- Worsened by acidosis secondary to hypoperfusion
Why does hypokalemia occur in a MT?
R/t re-entry of K+ into transfused RBCs
What can cause decrease in coagulation pathways and activity of Factor 7a related to MT?
Metabolic acidosis
What can decrease citrate metabolism and platelet adhesion and function related to MT?
Hypothermia
Blood products are what type of IV fluid?
Hypertonic
For at risk patients, when giving blood products, you should also give…
Diuretic!
- help prevent pulmonary edema
Too much transfusion can cause….
immunosuppression
