Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PCM IV Final > HYHO: Sepsis > Flashcards

HYHO: Sepsis Flashcards

1
Q

4 Types of Shock

A
    1. Cardiogenic shock
    1. Hypovolemic shock
    1. Distrubutive shock
    1. Obstructive shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is PCWP and CVP?

A
  • PCWP = pulmonary capillary wedge pressure (indirect measure of left atrial pressior and volume status of heart) is measured catheter in pulmonary artery
  • CVP = central venous pressure = marker for right atrial pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cardiogenic Shock

  1. What is it?
  2. Cardiac output (CO)
  3. SVR?
  4. PCWP or CVP?
A
  1. <3 does not pump well or circulatory overload (Heart attack, end-stage heart conditions)
  2. CO = decrease
  3. SVR = increase
  4. PCWP/CVP = increase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hypovolemic Shock

  • What is it?
  • Cardiac output (CO)
  • SVR?
  • PCWP or CVP?
A
  1. Poor fluid intake/ fluid or blood loss (sweating, diarrhea, vomitting, hemorrhage)
  2. CO = decrease
  3. SVR = increase
  4. PCWP/CVP = decrease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Septic/Anaphalctic (Distributive) Shock

  1. What is it?
  2. Cardiac output (CO)
  3. SVR?
  4. PCWP or CVP?
A
  1. Vasodilation, leading to low SVR
  2. CO = increase
  3. SVR = decrease
  4. PCWP/CVP = decrease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Neurogenic (Distributive) Shock

  1. What is it?
  2. Cardiac output (CO)
  3. SVR?
  4. PCWP or CVP?
A
  1. Vasodilation, leading to low SVR
  2. CO = decreased
  3. SVR = decreased
  4. PCWP/CVP = decreased
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Obstructive Shock

  1. What is it?
  2. Cardiac output (CO)
  3. SVR?
  4. PCWP or CVP?
A
  1. Obstruuction of blood flow in major circuit (extracardiac causes of HF: PE, cardiac tamponade, tension pneumo, constrictive pericarditis)
  2. CO = decreased
  3. SVR = increase
  4. PCWP/CVP = variable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sepsis

A

Life-threatening organ dysfunction caused by a dysregulated host response to an infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Sepsis (organ dysfunction) is defined by a qSOFA score or SOFA score ____

A

≥ 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what does qSOFA mean

A

quick Sequential Organ Failure Assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is advantage between qSOFA vs SOFA?

A
  1. qSOFA = can be done at bedside with NO labs
  2. SOFA = needs labs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

qSOFA Criteria

A
  1. RR > 22
  2. Systemic BP < 100 mmHg
  3. Altered mentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What 6 systems are evaluated in SOFA?

A
  1. Respiration
  2. Coagulation
  3. Liver
  4. CV
  5. CNS
  6. Renal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Sepsis is associated with an inpatient mortality ____ %

A

≥ 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is septic shock?

A

Subset of septic patients in which circulatory and cellular metabolism abnormalities are profound and substantially increase the risk of hospital mortality (>40%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is clinical standpoint of septic shock?

A

sepsis with persisting hypotension requiring vasopressors to maintain MAP ≥ 65 mmHg + serum lactate > 2 mmol/L, despite adequate volume resuscitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Sepsis Algorithm

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Signs and symptoms of shock (all types)

A
  1. Tachycardia
  2. HypOtension
  3. AMS
  4. Oliguria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Signs and symptoms of sepsis

A
  1. Temperature ( > 38 °C or < 36°C)
  2. HR (> 90)
  3. Tachypnea (RR > 20)
  4. Leukocytosis (WBC > 12,000) or leukopenia (WBC < 4000)
  5. Signs of end-organ perfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are signs of end-organ perfusion?

A
  1. Early sepsis: warm extremities d/t vasodilation (compared to cardiogenic shock, which has cool extremities)
  2. If Septic shock develops, extremities can become cool from redirection of blood to core organs
    1. Skin mottling
  3. CNS: AMS
  4. Kidney: Oliguria or anuria
  5. Bowel: No bowel sounds or ileus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What lab tests should you run to assess for DIC, a complication of sepsis?

A
  1. PT (INR)/PTT
  2. Fibrinogen
  3. D-dimer
  4. Peripheral blood smear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why would you run a CMP in a patient with sepsis?

A
  1. Acute liver injury
  2. AKI
  3. Electrolytes
23
Q

Why would you run a CBC with differential in a patient with sepsis?

A
  1. Leukocytosis/leukopenia
  2. Anemia
  3. Thrombocytopenia
24
Q

Why would you run a ABG (arterial blood gas) in a patient with sepsis?

A

Assess for hypoxemia and ARDS (from PaO2:FiO2 ratio)

25
Why would you run a check **serum lactate** in a patient with **sepsis**?
Check for signs of **sepsis (poor organ perfusion)**
26
When are **procalcitonin levels** elevated in a patient with **sepsis**?
**Bacterial infections** and **sepsis** ## Footnote **Tool used to determine duration of ABX (particularly in CAP)**
27
Complications of **sepsis**
1. **DIC** 2. **Acute kidney injury** 3. **Acute hepatic injury** 4. **ARDS (acutre respiratory distress syndrome)**
28
How should you manage a patient that you SUSPECT has sepsis?
1. qSOFA \>2? 1. No =\> still suspect sepsis? If no, monitor and reval if needed. If see, proceed down. 2. Yes = look for evidence of organ dysfunction and conduct SOFA 1. SOFA \<2 = monitor and reval if needed. 2. SOFA \> 2 = Sepsis is confimed 2. Sepsis is confirmed. Now determine if the patient is in septic shock. To do so, ask: 1. Despite adequate fluid resuscitation, does the patient need vasopressors to maintain MAP \>65mmHg AND is their serum lactate \>2mmol/L. 2. ^If yes = septic shock!
29
Labs for **DIC**
1. Thrombocytopenia 2. Elevated PT/PTT 3. Elevated D-dimer and fibrin degradation products 4. Decreased fibrinogen 5. ABNL peripheral blood smear (schistocytes/helmet cells)
30
DIC can cause what problems?
1. AKI 2. Acute hepatic injury 3. Acute lung injury 4. Neuro problems 5. Adrenal failure (Waterhouse - Friederischen syndrome) 6.
31
What is **ARDS**?
1. **Acute** and **diffuse inflammatory injury** to the **lungs**. 2. Many causes: **85%** of cases due to 1. **Pneumonia** 2. **Aspiration of stomach contents** 3. **Sepsis**
32
Diagnosis of **ARDS**
* 1. Onset within 7 days of initial insult * 2. Bilateral opacities on CXR or Chest CT consistent with pulmonary edema, * 3. Low PaO2:FiO2 ratio (\< 300 mmHg)
33
Initially, how do you treat a patient with **sepsis**?
**Stabilize** the patient hemodynamically + **determine the cause** of sepsis
34
To treat sepsis, you need **good vascular access** for hemodynamic monitoring. What do you need?
1. **2 large bore peripheral IVs** 2. **Central line,** typically in right internal jugular vein (to administeral vasopressor) 3. **Arterial line** 4. **Urinary foley catheter** * **​**(To measure accurate urine output to monitor renal function; goal _\>_ 0.5 ml/kg/hour)
35
What is the **1 hour bundle** for treatment of sepsis?
Surviving Sepsis Campaign recommends you need all of the following **within 1 hour** of realizing pt has sepsis/septic shock. In order: 1. Measure lactate level. If initially elevated (\>2mmol/L), remeasure. 2. Get blood cultures before giving ABX 3. Administer broad spectrum ABX 4. Begin rapid administration of 30 mL/ kg of IV fluids (crystalloid) for hypOtensive pts or lactate _\>_ 4mmol/L. 5. Give vasopressors if hypotensive during or after fluid resusitation to keep MAP _\>_ 65mmHg. 1. **NE** = preferred. 2. If still need to meet goal, give **Vasopressin** or **EPI**. 3. If nothing else works, add **Dobutamine**.
36
70 kg male with hypotension and sepsis would get ____ ml of IVF bolus with additional fluid as needed per hemodynamic status
**2100**
37
What are **crystalloid fluids?**
1. **Lactated ringers** 2. **Normal Saline**
38
\_\_\_\_\_\_ is used as a marker of **tissue hypoperfusion**
**Lactate**
39
**Name Vasoperssin Receptors (5)**
1. **a-1** 2. **B-1** 3. **B-2** 4. **D1** 5. **V1/2 (vasopressin-R)**
40
**a-1 receptors** 1. Location 2. Activation causes:
1. **Vascular smooth muscle** 2. **Vasoconstriction**
41
**_B-1 receptors_** 1. Location: 2. Activation causes:
1. **Heart** 2. Increases HR (**chronotropy**) and contraction of heart (**inotropy**)
42
**B-2 receptors** 1. Location: 2. Activation causes:
1. **Vascular** and **bronchial smooth muscles** 2. **Vasodilation** and **bronchodilation**
43
**_Dopamine Receptors (D1)_** 1. Location: 2. Activation causes:
1. **Renal** and **splanchnic (mesenteric) vascular beds** 2. **Vasodilation**
44
**_V-1 receptors_** 1. Location: 2. Activation causes:
1. **Vascular smooth muscle** 2. **Vasoconstriction**
45
**_V-2 receptors_** 1. Location: 2. Activation causes:
1. **Renal collecting duct** 2. **Anti-diuresis**
46
**Bronchi** Chapmans Points
1. **Anterior**: ICS between the 2nd/3rd ribs at the sternocostal junction, bilateral 2. **Posterior**: midway between the SP and the tip of the TP of T2, bilateral
47
**Upper Lung Chapman Points**
1. Anterior: ICS between the 3rd and 4th ribs at the sternocostal junction, bilateral 2. Posterior: in between the TP of T3 and T4, midway between the SP and the tip of the TP, bilateral 3.
48
**Lower Lung Chapmans Points**
* Anterior: ICS between the 4th and 5th ribs at the sternocostal junction, bilateral * Posterior: in between the TP of T4 and T5, midway between the SP and the tip of the TP, bilateral
49
**Liver and GB chapmans points**
* Anterior: _right_ ICS between the 5th, 6th, and 7th ribs, from the mid-mammillary line to the sternum * Posterior: between the TP of T5, T6, and T7, midway between the tips of the SP and the TP, right side only
50
**Kidney Chapmans Points**
* **Anterior**: 1 inch above the BB, laterally on either side of the midline * **Posterior**: between the TP of T12 and L1, midway between the tips of the SP and the TP, bilateral
51
ANS of **Heart, Lungs, Liver and Kidney**
1. **Heart**: T1-T6, Parasympathetics Vagus Nerve (OA, AA) 2. **Lungs**: T1-T7, Parasympathetics Vagus Nerve (OA, AA) 3. **Liver**: T5-T9, Parasympathetics Vagus Nerve (OA, AA) 4. **Kidney**: T10-T11, Parasympathetics Vagus Nerve (OA, AA)
52
\_\_\_\_\_\_ = is the most important action in the urgent setting in septic patient
**Stabilizing patient**
53
**_5 factor model for septic patient_** 1. Biomechanical 2. Respiratory/Circulatory 3. Neurologic 4. Metabolic/Energetic/Immune 5. Behavioral
1. Biomechanical – OMT for SD 2. Respiratory/Circulatory – Fluid status, vent settings, lymphatic OMT treatments 3. Neurologic – PT/OT for any neurologic compromise, OMT to normalize sympathetics and parasympathetics 4. Metabolic/Energetic/Immune – Assess ability for oral intake versus TPN, renal/hepatic dosing of meds, monitor ins and outs, daily weights 5. Behavioral – Address factors leading to sepsis
54

PCM IV Final (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions