Sepsis

Question 1

What are the stages of shock?
A-2
b-3
c-14
d-6

Answer 1

Initial-Switching from anaerobic to aerobic increase lactate
compensatory-Normal BP, Risk forP illius,temp can be normal or abnormal
progressive-Drop in BP, increase HR, Temp is all over, Cold clammy, Jaundice, DysR, MI, Ischemia in extremities, metabolic Acidosis, ARDS moist crackles, Ulcers, bleeding, change in labs
refractory-Unresponsive, fixed dilated pupils, bradyc, annurea, Hypot, molted cynotic skin

Question 2

What do we do for shock Assessment?
8

Answer 2

Monitor at risk patients
If they have shock-
Neuro q1-2hr
Cardiac monitoring and vital signs
respiratory and o2
Urine output and Labs for kidneys
Bowel sounds q 4 hr
frequent turns
Hygiene

Question 3

What is SIRS?
triggers 4

Answer 3

Systemic inflam response syndrome Triggered by infection, ischemia, infarction, and injury

Question 4

What is SIRS criteria 6

Answer 4

Temp greater than 101 or less than 96.8
HR >90
RR>20
WBC>12,000 or <4,000
Altered Mental status
HIgh BG

Question 5

How is SEPSIS measured

Answer 5

2 SIRS criteria and suspicion of infection

Question 6

What are the stages of sepsis

Answer 6

SIRS
SEPSIS
Severe Sepsis-Signs of organ damage Lab changes, HypoTN, fluid improves condition
Septic shock-Decreasing BP and s/s of organ damage pressors

Question 7

What is the sepsis bundle?

Answer 7

Measure lactate-If <2 remeasure if <4 septic
Get blood cultures but don’t delay antibiotics
-Two sites or two draws 15 mins apart from
same site
Fluids-30ml/kg (ideal body weight) for hypoTN or >4 lactate
Vassopressors if fluid doesnt help maintain MAP over 65

Question 8

MAP equation
Normal?
CVP

Answer 8

MAP=2xDBP+SBP/3
Normal 70 to 100
CVP-8-12

Question 9

What is MODS
5

Answer 9

Multiple organ damage. When two or more organs are failing. HOmeostasis cant be maintained without intervention. Develops from SIRS inflam response increased permeability High mortality

Question 10

What systems do we watch for with MODS
9

Answer 10

respiratory, Cardiovascular, neuro, GI/GU, Metabolic Changes, coag problems-DIC, Acidosis, electrolyte issues. insulin issues and BG

Question 11

Describe the different stages of shock:
Compensatory
Progressive
Irreversible (Refractory)
(What is going on in each? What will we see symptoms wise?)
MEgans

Answer 11

Compensatory- Inc B/P, inc HR, dec blood flow to kidneys, GI, skin=pale, inc Na, tachypneic, A&O X3-slight confusion, restlessness
Progressive- dec responsiveness, further dec in perfusion, dec CO, dec B/P, inc HR, dec U.O, skin cold, clammy, tissue hypoxia-lactic acidosis=metabolic acidosis
Irreversible (Refractory)- unresponsive, severe hypotension, dec HR, hypoxemia, resp failure, anuria, hypothermia, mottled cyanotic skin

Question 12

Most Common cause of SIRS

Answer 12

Bacteria
tx prevent infection

Question 13

4 goals of fluid

Answer 13

CVP 8-12, MAP >65, UOP 0.5ml/kg/hr, normal lactate level

Question 14

What are causes of SIRS?

Answer 14

MI, trauma, burns, pancreatitis, clots, infection= bacteria, fungi, viruses