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PCM 4 exam 2 > HYHO: SEPSIS > Flashcards

HYHO: SEPSIS Flashcards

1
Q

Cardiogenic shock

A

results from poor pumping fxn or circulatory overload

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2
Q

Hypovolemic shock

A

results from poor fluid intake or excessive fluid loss (sweating, diarrhea, vomiting, hemorrhage)

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3
Q

Distributive shock

A

results from vasodilation leading to low SVR (sepsis, anaphylaxis, hepatic failure, neurogenic shock-autonomic dysfxn from TBI, spinal cord injury)

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4
Q

Obstructive shock

A

from extracardiac causes of heart failure (ex. cardiac tamponade, pulmonary embolism, tension pneumothorax, constrictive pericarditis)

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5
Q

which type of shock has increased CO, while all the others have decreased CO

A

Septic and anaphylactic distributive shock

Note: neurogenic shock has decreased tho

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6
Q

which type of shock has decreased systemic vascular resistance (SVR), while all the others have increased SVR

A

distributive shock (both subtypes)

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7
Q

which type of shock has increased pulmonary capillary wedge pressure (PCWP) ?

A

cardiogenic shock

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8
Q

which type of shock has variable pulmonary capillary wedge pressure (PCWP) or Central venous pressure(CVP) ?

A

obstructive shock

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9
Q

Sepsis definition

A

life-threatening organ dysfxn caused by dysregulated host response to an infection

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10
Q

organ dysfunction is defined by what scores

A

qSOFA score or SOFA score > or equal to 2

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11
Q

qSOFA score** and advantage of it

A

quick sequential organ failure assessment
**
RESP RATE >/22/ min
ALTERED MENTATION
SBP /<100 mmHg
**
advantage: Can be completed bedside with no need for labs

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12
Q

SOFA

A

Sequential Organ Failure Assessment

needs lab data to complete

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13
Q

6 systems involved in the SOFA score

A

respiration

coagulation

liver

CV

CNS

Renal

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14
Q

prognosis of sepsis

A

inpatient mortality > or equal to 10%

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15
Q

Septic shock

A

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

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16
Q

prognosis of septic shock

A

substantially increase risk of hospital mortality >40%

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17
Q

Glasgow Coma Scale

A
  • has 3 diff categories (eye opening, verbal response, best motor response)
  • score 3-15 (15 = best)
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18
Q

Sepsis algorithm (apparently we have to memorize this and im kinda upset about it but how many questions max will it be like cmon)

A

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

19
Q

a person presenting with septic shock would have what signs and syxs

A

hypotension
tachycardia
altered mental status
oliguria

cool extremities (espec cardiogenic shock)

skin mottling

20
Q

signs and syx of sepsis

A

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)
21
Q

diagnostic evaluation

A

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.)

22
Q

complications of sepsis

A
  1. DIC
  2. AKI
  3. Acute hepatic injury
  4. ARDS
23
Q

DIC labs

A
  • thrombocytopenia
  • elevated PT/PTT
  • elevated D-dimer and fibrin degradation products
  • decreased fibrinogen levels
  • abnormal peripheral blood smear (schistocytes + helmet cells present)
24
Q

what is needed for dx of ARDS

A

PaO2: FiO2 ratio <300 mmHg

not necessary for dx, but might be impt to know:

CXR- bilateral opacities

25
Q

Treatment/mgmt of sepsi

A
  • place 2 large bore peripheral IVs
  • place central line (typically right internal jugular vein-RIJ catheter)
  • place arterial line
  • place urinary catheter (foley); goal urine output >/0.5 ml/kg/hr
  • endotracheal intubation if indicated
  • Hour 1 bundle
26
Q

what is the hour 1 bundle for sepsis mgmt

A
  1. measure lactate level
  2. obtain blood cultures prior to AB administration
  3. administer empiric broad-spectrum ABs
  4. fluid resuscitation w/ IV fluids (at least 30 ml/kg) for hypotensive pts or lactate >/4 ; crystalloid fluids are preferred
  5. Add vasopressors in adequately volume resuscitated pts to maintain MAP >/65 mmHg
27
Q

what vasopressors can you have in adequately volume resuscitated pts to maintain MAP >65 mmHg

A

Norepinephrine= preferred initial vasopressor

Vasopressin/Epinephrine = can be added as next vasopressor choice if still needed to meet MAP goal

Dobutamine = can be subseq added to pts with ongoing evidence of persistent hypoperfusion despite adequate fluid resusc and vasopressor agents

28
Q

If pt has lactate >2 what should you do

A

you need to repeat the lactate every few hrs until its normal

lactate = marker of tissue hypoperfusion

29
Q

a1 vasopressor receptor

A

located in vascular SM

activation–> vasoconstriction

ex. Phenylephrine, Norepinephrine, Epinephrine

30
Q

B1 vasopressor receptor

A

located mostly in heart

activation–> increases HR (chronotropy) and cardiac contraction (ionotropy)

ex. Epinephrine, Dobutamine

31
Q

B-2 vasopressor receptors

A

located in vascular and bronchial SMs

activation–> VD and bronchodilation

32
Q

Dopamine vasopressor receptors (D1)

A

located in renal and splanchnic (mesenteric) vascular beds

activation–> VD

33
Q

Vasopressin receptors (V1+V2)

A

V1: vascular smooth muscles; activation–> VC

V2: located in renal collecting duct; activation–> antidiuresis

34
Q

Chapmans point for bronchi

A

Anterior - ICS bw second and third ribs at the sternocostal jxn, bilateral

Posterior- midway bw spinous process and tip of the TP of T2, bilateral

35
Q

Chapmans point for upper lung/lower lung

A

UPPER LUNG:
anterior- ICS bw/ 3rd +4th ribs @SCJ, bilateral

posterior- in space bw TP of T3+T4, midway bw SP and tip of TP, bilateral

LOWER LUNG:

anterior- ICS b/w 4th and 5th ribs @SCJ, bilateral

posterior- in space bw TP of T4+T5, midway bw SP and tip of TP, bilateral

36
Q

Chapmans pt for liver/GB

A

anterior- ICS bw 5th,6th, and 7th ribs (from mid mamm line to sternum); R side only

posterior- bw TP of T5,T6, and T7, midway bw tips of SP and TP); R side only

37
Q

Chapmans pt for kidney

A

anterior- one inch above umbilicus, laterally on either side of midline

posterior- bw TP of T12 + L1, midway bw SP and TP, bilateral

38
Q

autonomic - parasympathetic innervation of heart, lungs, liver, kidney

A

parasympathetics: Vagus n. (OA, AA)

39
Q

autonomic sympathetic innervation for heart

A

T1-T6

40
Q

autonomic sympathetic innervation of lungs

A

T1-T7

41
Q

autonomic sympathetic innervation for liver

A

T5-T9

42
Q

autonomic sympathetic innervation for kidney

A

T10-T11

43
Q

5 models of care for septic pt

A

most impt action = STABILIZE PT

biomechanical: OMT as indicated for SDs

respiratory/circulatory: fluid status, vent settings, lymphatic OMT txs

neurologic: PT/OT for any neuro compromise, OMT to normalize sympathetics + parasympathetics

metabolic/energetic/immune: assess ability for oral intake vs. TPN, Renal/hepatic dosing of meds, monitor ins and outs, daily weights

behavior: address factors leading to sepsis

PCM 4 exam 2 (6 decks)

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