fluid rescucitation in sepsis

Question 1

hypotension in sepsis is classified as

Answer 1

systolic blood pressure less than 90 or diastolic blood pressure less than 60
OR 40mmHg less than there normal blood pressure

Question 2

the normal physiological response to local infection

Answer 2

is the activation of host defence mechanisms which causes influx of activated neutrophils and monocytes, release of inflammatory mediators, local vasodilation, increased endothelial permeability and activation of the coagulation cascade

Question 3

hypotension in sepsis occurs due to

Answer 3

the induction of nitric oxide which causes arterial vasodilation which results in reduced total peripheral resistance which causes compensatory rise in cardiac output initially (BP=COxTPR) but this eventually fails causing hypotension, also in sepsis there is increased capillary permeability which causes a fall in intra-vascular volume

Question 4

hypotension causes

Answer 4

tissue hypo perfusion which causes hypoxia, hypoxia causes anaerobic metabolism causing a lactic acidosis

Question 5

white blood cells release

Answer 5

lytic enzymes and reactive oxygen species to destroy the pathogen but also causes collateral damage to blood vessels all over the body

Question 6

damaged blood vessels cause

Answer 6

the activation of the coagulation cascade which occurs in vessels all over the body so eventually clotting factors get depleted and blood starts to spill out of blood vessels which is called disseminated intra-vascular coagulation

Question 7

sepsis can also cause

Answer 7

acute respiratory distress syndrome where there is increased capillary permeability which causes a non-cariogenic pulmonary oedema

Question 8

lactic acidosis causing an increase in cell

Answer 8

apoptosis which particular affects the cells of the heart ad the kidneys causing them to eventually fail

Question 9

signs of hypovolaemia

Answer 9

cool peripheries, clamminess, dry mucous membranes, decreased JVP, tachycardia, hypotension, reduced urine output, mottled skin, skin turgor

Question 10

why does resp rate increase in sepsis

Answer 10

because the patients tries to blow off co2 to compensate for the lactic acidosis

Question 11

as part of the sepsis 6 bundle

Answer 11

urine output should be monitored hourly, a normal amount of urine production is 0.5mmls/kg/ hour any less than this is oliguria and indicates hypo perfusion of the kidneys

Question 12

fluids used in sepsis should be

Answer 12

crystalloid fluids which is fluid containing electrolytes either saline (0.9% NaCl) or hart mans solution can be used

Question 13

colloid fluids are designed to

Answer 13

maintain oncotic pressure as they contain artificial starches or proteins that keeps flip in the intra-vascular compartment however, clinically the are not better than crystalloid fluids and they are more expensive and there is a risk of hyper-sensitivity reactions occurring

Question 14

fluid dosing in sepsis

Answer 14

500ml stat and monitor response, most patients require at least 2 litres of fluid to restore euvolaemia

Question 15

septic shock

Answer 15

patients remains profoundly hypotensive despite adequate IV fluid resuscitation due§ to persistent vasodilation

Question 16

patients with septic shock

Answer 16

require inotropic support/ vasoconstrictors which should be derived in ICU though a central venous line

Question 17

aim in septic shock is to get MAP

Answer 17

above 65mmHg