Sepsis Flashcards
Septic Shock Criteria
Sepsis
Plus signs of end organ damage
Plus Hypotension (SBP<90)
Lactate >4
Not responding to IVF
CBC would show bands - immature neurtrophils
What are the most common sources of sepsis
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)
Lactate and Procalcitonin in Sepsis
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
What is the relationship between lactate and PEtCO2
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
What are the major components of the management of the septic patient
Volume resuscitation - 30mL/kg for the first 3 hours - prefer LR
Vasopressors
Antibiotics
Adjuncts (steroids, glycemic control, nutrition, renal replacement)
Phenylephrine vs Epinephrine: Which to give in sepsis
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
Broad spectrum antibiotics in sepsis
Per hospital protocols
Should be started within 1 hour
Vancomycin - broad spectrum gram pos
Cefepime - broad spectrum gram neg
Glycemic control in sepsis
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
What are types of distributive shock?
Distributive shock - Massive Vasodilation
Septic
Anaphylactic
Neurogenic
Hypovolemic shock: What causes it and what are the lab values?
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
Management of Hypovolemic Shock
-Fluid resuscitation is the mainstay of treatment (isotonic)
-Vasopressor support (norepinephrine, dopamine, dobutamine)
-pRBC when indicated (if low H/H)
Obstructive Shock: What is it and what are the common causes
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
What are the laboratory studies associated with Obstructive Shock?
-Decreased CO/CI
-High SVR
-Normal/decreased Wedge Pressure
-Increased Central Venous Pressure
How do manage Obstructive Shock
Maintain blood pressure while initiating treatment of the underlying cause
Fluid administration
Vasopressors
Mechanical ventilation as indicated
Anticoagulation, as indicated
In Anaphylactic and Neurogenic shock, what are the hemodynamics?
All of them are low
There is massive vasodilation which causes everything to be low