Fluid Resus in Sepsis

Question 1

what effect does nitric oxide have on the blood vessels?

Answer 1

vasodilation

Question 2

why do you get tachycardia in sepsis?

Answer 2

bacteria makes toxins which stimulates cytokines
NO produced -> vasodilation
TPR falls so CO increases to compensate (BP= TPR x CO)

Question 3

why do you get hypotension in sepsis?

Answer 3

bacteraemia causes leaky blood vessels = decreased intravascular volume

Question 4

what effect does metabolic acidosis have on the body?

Answer 4

exacerbates vasodilation
negative inotropic effect
cell function impaired

Question 5

signs of hypovolaemia?

Answer 5

cool peripheries
clammy
dry mucous membranes
mottled skin
low urine output
decreased JVP
tachycardia
hypotension

Question 6

normal lactate value?

Answer 6

<1.8mmol/l

Question 7

high lactate indicates what?

Answer 7

tissue hypoperfusion from metabolic acidosis

Question 8

what should urine output be per hr?

Answer 8

0.5ml per kg of person per hr

Question 9

what should hourly urine output be for a 60kg person?

Answer 9

30ml

Question 10

what is the term for low urine output?

Answer 10

oliguria

Question 11

how is urine output measured?

Answer 11

1. urine volumes measured (healthier pts)

2. urinary catheter

Question 12

oliguria is an early indication of..

Answer 12

renal hypoperfusion

Question 13

NaCl fluid is an example of what type of fluid?

Answer 13

crystalloid

Question 14

name the 2 categories of fluid used clinically

Answer 14

crystalloids

colloids

Question 15

give an example of a crystalloid

Answer 15

NaCl

hartmanns

Question 16

how should you fluid resuscitate a patient?

Answer 16

give 500ml 0.9% saline as a bolus

reassess RR, BP, pulse, urine output

Question 17

if the patient is still septic after fluid resus and are clinically euvolaemic what is wrong?

Answer 17

low TPR due to vasodilation -> septic shock

Question 18

what inotropic support should be offered for a septic patient?

Answer 18

alpha agonist eg noradrenaline

alpha/beta agonist eg adrenaline