HYHO: SEPSIS Flashcards
Cardiogenic shock
results from poor pumping fxn or circulatory overload
Hypovolemic shock
results from poor fluid intake or excessive fluid loss (sweating, diarrhea, vomiting, hemorrhage)
Distributive shock
results from vasodilation leading to low SVR (sepsis, anaphylaxis, hepatic failure, neurogenic shock-autonomic dysfxn from TBI, spinal cord injury)
Obstructive shock
from extracardiac causes of heart failure (ex. cardiac tamponade, pulmonary embolism, tension pneumothorax, constrictive pericarditis)
which type of shock has increased CO, while all the others have decreased CO
Septic and anaphylactic distributive shock
Note: neurogenic shock has decreased tho
which type of shock has decreased systemic vascular resistance (SVR), while all the others have increased SVR
distributive shock (both subtypes)
which type of shock has increased pulmonary capillary wedge pressure (PCWP) ?
cardiogenic shock
which type of shock has variable pulmonary capillary wedge pressure (PCWP) or Central venous pressure(CVP) ?
obstructive shock
Sepsis definition
life-threatening organ dysfxn caused by dysregulated host response to an infection
organ dysfunction is defined by what scores
qSOFA score or SOFA score > or equal to 2
qSOFA score** and advantage of it
quick sequential organ failure assessment
**
RESP RATE >/22/ min
ALTERED MENTATION
SBP /<100 mmHg
**
advantage: Can be completed bedside with no need for labs
SOFA
Sequential Organ Failure Assessment
needs lab data to complete
6 systems involved in the SOFA score
respiration
coagulation
liver
CV
CNS
Renal
prognosis of sepsis
inpatient mortality > or equal to 10%
Septic shock
subset of septic patients in which circulatory and cellular metabolism abnormalities are profound
-SEPSIS w/ persisting hypotension requiring vasopressors to maintain MAP>/65 mmHg AND having serum lactate >2mmol?L despite adequate volume resuscitation
prognosis of septic shock
substantially increase risk of hospital mortality >40%
Glasgow Coma Scale
- has 3 diff categories (eye opening, verbal response, best motor response)
- score 3-15 (15 = best)
Sepsis algorithm (apparently we have to memorize this and im kinda upset about it but how many questions max will it be like cmon)
you suspect pt infection–> check qsofa–> if 2 or greater, assess for evidence of organ dysfxn thru SOFA–> if 2 or greater–> SEPSIS
**if no to either of above Qs—> monitor clinical condition and reevaluate for possible sepsis if clinically indicated
once got dx of SEPSIS, check for SEPTIC SHOCK if ALL of these are a YES==> 1) vasopressors required to maintain MAP >/65 mmHg AND 2) serum lactate level >2 mmol/L (all despite adequate fluid resusc)
if no then its sepsis
a person presenting with septic shock would have what signs and syxs
hypotension
tachycardia
altered mental status
oliguria
cool extremities (espec cardiogenic shock)
skin mottling
signs and syx of sepsis
non-specific but include:
Temp >38C or <36C
HR>90
Tachypnea (RR>20)
leukocytosis(>12000) or leukopenia (<4000)
signs of end organ perfusion:
- early= warm extremities–> can become cool if septic shock develops)
- skin mottling (septic shock)
- CNS altered mental status
- kindey (oliguria)
- bowel (absent bowel soudns or ileus often signs of end-organ hypoperfusion)
diagnostic evaluation
CMP (acute liver/kidney injury, electrolytes)
CBC w/ diff
PT(INR), PTT, fibrinogen, D-dimer, periph blood smear (assess for DIC)
arterial blood gases (hypoxemia, possible ARDS)
Serum lactate (poor organ perfusion)
plasma procalcitonin (bacterial infections, sepsis; helpful tool for determining duration of antibiotics)
identify source of infection (maybe urinalysis w/ micro, urine culture, blood culture, sputum, etc.)
complications of sepsis
- DIC
- AKI
- Acute hepatic injury
- ARDS
DIC labs
- thrombocytopenia
- elevated PT/PTT
- elevated D-dimer and fibrin degradation products
- decreased fibrinogen levels
- abnormal peripheral blood smear (schistocytes + helmet cells present)
what is needed for dx of ARDS
PaO2: FiO2 ratio <300 mmHg
not necessary for dx, but might be impt to know:
CXR- bilateral opacities
