Exam 1: Infection and Shock Flashcards
Airborne isolation
- Negative airflow rooms required to prevent spread of microbes
- HEPA filter
- For TB, measles, chickenpox
Droplet isolation
Protect from droplets that may travel 3 feet but are not suspended for long periods
For influenza, mumps, pertussis, meningitis
Contact isolation
- For known or suspected infections transmitted by direct contact or contact with items in environment
- For MRSA, pediculosis, scabies, RSV, C. difficile
CDC prevention guidelines
- Practice hand hygiene, proper handwashing
- Personal protective equipment (PPE)
MRSA and VRE treatment and prevention
- Vancomycin
- Linezolid
Health teaching best way to decrease incidence
- Perform frequent hand hygiene, including use of hand sanitizers
- Avoid close contact with people with infectious wounds
- Avoid large crowds
- Avoid contaminated surfaces
- Use good overall hygiene
Management of Ebola in hospital
- IV fluid & electrolyte replacement
- Oxygen & ventilation support
- Blood pressure support
- Care & Comfort
- Symptomatic care
- Emotional support
Bioterrorism isolation
- Anthrax: Standard Precautions
- Botulism: Standard Precautions
- Plague: Droplet & Contact
- Smallpox: Standard, Contact & Airborne
Hypovolemic Shock etiology
- Total body fluid decreased
- Hemorrhage, Dehydration
Hypovolemic Shock symptoms
- Increased HR
- Decreased blood pressure
- Narrowed pulse pressure
- Postural hypotension
- Flat neck and hand veins in dependent positions
- Slow capillary refill
- Pale, cool, moist skin
- Decreased cardiac output/cardiac index (know numbers)
- Low central venous pressure (CVP)
- Decreased PAWP
- Increased SVR
- Increased RR (Decreased Paco2/Decreased Pao2)
Distributive shock etiology
- Blood volume distributed to interstitial tissues where it cannot circulate, deliver oxygen
- Caused by loss of sympathetic tone, blood vessel dilation, pooling of blood in venous and capillary beds, capillary leak
- Neural-induced distributive shock
Neurogenic - Chemical-induced distributive shock
Anaphylaxis, Sepsis, Capillary leak syndrome
Distributive shock from anaphylaxis symptoms
- Decreased BP
- Increased HR, tachycardia
- Increased RR, tachypnea
- Cough, dysphagia
- Hoarseness
- Stridor
- Wheezing
- Rales/rhonchi
- Restlessness, anxiety, apprehension
- Pruritis, erythema, urticaria
- Angioedema
- Decreased CO/CI
- Decreased CVP
- Decreased PAWP
- Decreased SVR
Distributive shock from neurogenic symptoms
- Hypotension
- Bradycardia
- Warm, dry, skin
- Hypothermia
- Bounding pulse
- Decreased CO/CI
- Decreased CVP
- Decreased PAWP
- Decreased SVR
Distributive shock from septic symptoms
- Increased HR
- Decreased BP
- Wide pulse pressure
- Full, bounding pulse
- Pink, warm, flushed skin
- Increased RR
- Crackles
- Change in sensorium
- Increased temperature
- Increased CO/CI
- Decreased SVR
- Decreased CVP
- Decreased PAWP
- Increased SvO2
Sepsis pathophysiology
When SIRS is a result of infection
Sepsis symptoms
- Temp> 38 C° or < 36° C
- HR > 90 bpm
- RR > 20 per min
- Altered mental status
- fluid balance > 20ml/kg in 24hrs
- Glucose >140 mg/dl
- WBC > 12,000/mm3, < 4,000/mm3, or > 10% bands
- Elevated C-reactive protein
- Elevated plasma procalcitonin
- SBP < 90 mm Hg or a decrease >40 mm Hg
- MAP < 70 mm Hg
- Svo2 > 70%
- CI > 3.5 L/m
- Serum lactate > 1 mmol/L
- Pao2/Fio2 < 300
- UOP < 0.5 ml/kg/hr
- Creatinine increase > 0.5 mg/dl
- INR > 1.5 or aPTT > 60 sec
- Absent bowel sounds, Ileus
- Platelet count < 100
- Hyperbilirubinemia > 4mg/dl
SCCM guidelines: within 3 hours of presentation
- Measure lactate level
- Obtain blood cultures prior to the administration of antibiotics
- Administer 30 ml/kg of crystalloid for hypotension or lactate > 4 mmol/L
SCCM guidelines: within 6 hours of presentation
- Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a mean arterial pressure (MAP) ≥65mmHg
- In the event of persistent hypotension after initial fluid administration (MAP < 65 mm Hg) or if initial lactate was ≥4 mmol/L, re-assess volume status and tissue perfusion
- Re-measure lactate if initial lactate elevated
Hypovolemic shock treatment
- fluid or blood replacement
- possible vasopressors
Distributive shock from anaphylaxis treatment
- Epinephrine
Distributive shock from neurogenic treatment
- small fluid bolus
- vasopressors
Norepinephrine
first choice for vasopressor
Vasopressin
0.03 units/min as an alternative or in addition
Dopamine
- vasoconstrictor
- for pts with low HR
Dobutamine
- vasoconstrictor
- for pts with low cardiac output
Corticosteriods (hydrocortisone)
ONLY if fluid and vasopressor therapy not effective
complications of shock: DIC
- Failure of the coagulation system in SIRS
- Dysfunction of hematologic system in MODS
- Precipitated by insult to body
- Results in hypercoagulopathy –
“out of balance”
Microvascular clotting
Hemorrhage
Cardiac Output (CO) normal value
Normal CO: 4-7 L/min
- Amount of blood pumped out by the ventricle per minute
Central Venous Pressure (CVP or RAP) normal value
Normal CVP: 2-5 mmHg
- Reflects filling pressures of the right side of the heart
Cardiac Index (CI) normal value
Normal CI : 2.2-4.0 L/min/m2
- Adjusts CO for body size
- More precise
Systemic Vascular Resistance (SVR) normal value
Normal 800-1400 dynes/sec/cm
- The resistance against which the left ventricle must pump to eject its volume
SVO2 (return of blood back to the right side of the heart) normal value
Normal value 60%-80%
Stroke volume variation (SVV) normal range
Normal SVV < 10-15%
- If SVV is >15%, patient’s cardiac output will increase with fluid infusion
PLR (passive leg raising)
simple, reversible maneuver that mimics rapid fluid loading and increases cardiac preload. This
procedure enables the tester to obtain accurate measurements to help classify spontaneously breathing
patients as responders or nonresponders.
Normal BP
120/80
