Inflammatory Shock Syndromes Flashcards
What is the most common manifestation of inflammatory organ injury in the ICU?
ARDS
What is the SIRS criteria?
2 of the following:
- Temperature above 38 or below 36
- WBC above 12K or below 4K or with more than 10% bandemia
- Rr above 20 or PaCO2 less than 32
- Heart rate above 90
What is the mechanism behind systemic vasodilation in septic shock?
The release of the free radical, nitric oxide from endothelial cells
Where blood flow is typically reduced in shock?
Splanchnics which leads to disruption of intestinal mucosal barrier
What are the steps in treating shock?
- Obtain cultures
- Obtain a lactate level
- Administer antibiotics
- Get a line in and start fluids
What is the goal CVP in septic shock?
Between 8-12 mmHg
What are the guidelines for administering fluid in septic shock?
Give 500-1,000 ml of crystalloid or 300-500 ml of colloid in the first 30 minutes
What is an alternative rule for volume resuscitation in septic shock?
20 ml/kg of crystalloid
What is the rate at which norepinephrine can be infused for septic shock?
0.1 ug/kg/min
What is the goal MAP in septic shock?
Above 65 mmHg
What is the max dosage rate for norepinephrine before you should start a second agent?
3.5 ug/kg
What is the starting dose of dopamine for septic shock?
5 ug/kg/min
At what dose rate should you add a second agent to dopamine drip?
20 ug/kg/min
Why is norepinephrine usually preferred over dopamine in septic shock?
Because it is more likely to raise the bp and it is less likely to cause tachyarrythmias
What drug is used for refractory hypotension ?
Vasopressin
