Lecture 31 - Sepsis and Septic Shock

Question 1

Systemic Inflammatory Response Syndrome (SIRS) is the body’s response to a wide variety of clinical insults. It is considered SIRS when 2 or more of the following criteria are met:

1. Temp > ____ C (100.4) OR < ____ C
   2 (96.8).
2. HR > ____
3. RR > ____ or paCO2 < ____
4. WBC > ______ OR < ______ OR > ___% band cells.

Keep in mind when SIRS is in response to ______, we worry about end organ damage and Septic Shock.

Answer 1

1. Temp > 38C (100.4F) OR < 36C (96.8F)
2. HR > 90
3. RR > 20 or paCO2 < 32
4. WBC > 12,000 OR < 4,000 OR > 10% band cells

Question 2

Some host factors that contribute to the development of Sepsis, other than the obvious genetic predisposition, include underlying disease such as _____, heart disease, and _____, etc…

Answer 2

Diabetes, heart disease, Cancer, etc…

Question 3

Cardiovascular Compromise (or Shock) is defined as SBP < _____, or MAP < ____, or a decrease of ______mmHg in SBP from baseline. Also look for elevated lactate ( > _____). Look for patients to present with ____, ____ skin with possible vasoconstriction and resultant ______.

Answer 3

SBP < 90

MAP < 65

Decrease of at least 40 mmHG in SBP from baseline

Elevated lactate > 4

Cold, clammy skin

Cyanosis

Question 4

Patients with sepsis typically suffer from only 3 of the 4 types of cardiovascular shock. Either 1. ______ shock (vasodilation of the venous and arterial vessels), 2. _______ shock (loss of plasma volume), or 3. _______ shock (ventricular failure). They do not suffer from Obstructive shock.

Answer 4

1. Distributive
2. Hypovolemic
3. Cardiogenic

Question 5

About 20-30% of patients with sepsis experience a decrease in EF, which manifests as dilation of both ______, reduced responsiveness to _____, and decreased ______. The cytokines most responsible for this are ______, ______, and ______.

Answer 5

Ventricles

Fluids

CO

TNF-alpha

IL-beta

IL-6

Question 6

Elevated Lactate in Cardiovascular Compromise (Shock) is caused by different things, depending on the type of Cardiovascular Compromise.

In Low flow states (Hypovolemia and/or Cardiogenic shock) the primary mechanism for elevated lactate is Tissue _____ with ______ metabolism.

In Distributive shock, the elevated lactate also involves an increase in _______ (type of metabolism) and inhibition of ______ ______.

Elevated lactate may also be due to impaired ______ function (should make sense because it is the organ most responsible for clearing lactate).

Answer 6

Tissue Hypoxia with Anaerobic metabolism

Glycolysis

Pyruvate Dehydrogenase

Liver

Question 7

Coagulopathy is a common feature of acute sepsis. There are essentially 3 flavors:

1. _________
2. ________
3. ________

Answer 7

1. Thrombocytopenia
2. HYPERcoagulability
3. DIC

Question 8

Renal failure in Sepsis is characterized by dilation of both the ______ and ______ artirioles. Which dilates more, and what does that result in?

Answer 8

Afferent and Efferent

Efferent dilates more, which results in decreased GFR.

Question 9

Generally, patients who have an infection and have at least 2 of the following 3 criteria are considered to have Sepsis:

1. SBP < _____
2. _____ _____ _____
3. RR > ______

Answer 9

1. SBP < 100mmHg
2. Altered Mental Status
3. RR > 22