Sepsis Flashcards

1
Q

Septic Shock Criteria

A

Sepsis

Plus signs of end organ damage

Plus Hypotension (SBP<90)

Lactate >4

Not responding to IVF

CBC would show bands - immature neurtrophils

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2
Q

What are the most common sources of sepsis

A

Lungs and urinary tract by far (PNA, pyelonephritis)

This is followed by the abdomen (perf, abscess, c. diff)

Last are skin and skin structure infections (wounds, pressure ulcers)

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3
Q

Lactate and Procalcitonin in Sepsis

A

The higher the PCT, the higher the risk they are septic - more sensitive for sepsis
–Above 0.5 is concerning
–Will be elevated if bacterial origin but not viral
–used to determine when you can stop antibxs

CBC:
Leukocytosis is common but leukopenia could be worse given that the body may have used up all the neutrophils

Bandemia is common because there are a lot of immature neutrophils

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4
Q

What is the relationship between lactate and PEtCO2

A

As the lactate rises, the PEtCO2 drops

If you see a rising lactate and a dropping PEtCO2, that is bad because it means the tissue is not giving off CO2 and therefore you are not able to breathe it off

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5
Q

What are the major components of the management of the septic patient

A

Volume resuscitation - 30mL/kg for the first 3 hours - prefer LR
Vasopressors
Antibiotics
Adjuncts (steroids, glycemic control, nutrition, renal replacement)

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6
Q

Phenylephrine vs Epinephrine: Which to give in sepsis

A

Phenylephrine will help raise the blood pressure but will not affect the HR because it is a pure alpha

Epinephrine can cause more tachycardia given that it is alpha and beta

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7
Q

Broad spectrum antibiotics in sepsis

A

Per hospital protocols

Should be started within 1 hour

Vancomycin - broad spectrum gram pos
Cefepime - broad spectrum gram neg

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8
Q

Glycemic control in sepsis

A

Should obtain blood glucose levels from more central source than POCT given poor capillary circulation in sepsis

Goal should upper blood glucose <180 rather than <110 given concern for hypoglycemia

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9
Q

What are types of distributive shock?

A

Distributive shock - Massive Vasodilation

Septic
Anaphylactic
Neurogenic

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10
Q

Hypovolemic shock: What causes it and what are the lab values?

A

Results from a loss of >20% of circulating blood volume:
-Internal/external bleeding
-Burns
-DKA/HHS
-Severe dehydration

-Decreased Cardiac Output/Cardiac Index
-Decreased Central Venous Pressure
-Decreased Wedge Pressure
-Increased Systemic Vascular Resistance (compensating for the low CO/CI
-Decreased Mixed Venous O2 Sat

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11
Q

Management of Hypovolemic Shock

A

-Fluid resuscitation is the mainstay of treatment (isotonic)
-Vasopressor support (norepinephrine, dopamine, dobutamine)
-pRBC when indicated (if low H/H)

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12
Q

Obstructive Shock: What is it and what are the common causes

A

Inadequate cardiac output as a result of impaired ventricular filling

Causes:
-Massive PE
-Tension PTX
-Acute cardiac tamponade
-Obstructive valvular disease
-Disease of pulmonary vasculature

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13
Q

What are the laboratory studies associated with Obstructive Shock?

A

-Decreased CO/CI
-High SVR
-Normal/decreased Wedge Pressure
-Increased Central Venous Pressure

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14
Q

How do manage Obstructive Shock

A

Maintain blood pressure while initiating treatment of the underlying cause
Fluid administration
Vasopressors
Mechanical ventilation as indicated
Anticoagulation, as indicated

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15
Q

In Anaphylactic and Neurogenic shock, what are the hemodynamics?

A

All of them are low
There is massive vasodilation which causes everything to be low

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16
Q

What is neurogenic shock and how is it treated?

A

Loss of peripheral vasomotor tone as a result of spinal cord injury, regional anesthesia etc.

Treatment:
Maintain airway
Fluids for volume expansion
Vasopressors

17
Q

What is anaphylactic shock and how is it treated?

A

IgE mediated reaction that occurs shortly after exposure to an allergen

Treatment:
-Maintain airway
-Fluids for volume expansion
-Benadryl 25-75mg IV/IM (Hives - histamine)
-Epinephrine 0.3-0.5mg SQ or IM for respiratory distress, stridor or wheezing only
-IV glucocorticoids as needed
-Consider H2 antagonist
-Inhaled beta agonist for bronchospasm

18
Q

Hypovolemic shock: What causes it and what are the hemodynamics

A

Results from a loss of >20% of circulating blood volume:
-Internal/external bleeding
-Burns
-DKA/HHS
-Severe dehydration

Everything is low but SVR is high
-Decreased Cardiac Output/Cardiac Index
-Decreased Central Venous Pressure
-Decreased Wedge Pressure
-Increased Systemic Vascular Resistance (compensating for the low CO/CI)
-Decreased Mixed Venous O2 Sat

19
Q

Septic Shock - What are the hemodynamics

A

Everything is low with the exception of high cardiac output/cardiac index

It is the only shock state with a high cardiac output

20
Q

qSOFA - what does it measure and what are the criterion?

A

Used to identify patients with suspected infection who are at greater risk for poor outcome due to sepsis

-Low blood pressure (SBP<100)
-High respiratory rate (RR>22)
-AMS (GCS<15)

Presence of 2 or more is associated with greater risk of death or prolonged ICU stay