Sepsis Flashcards
What are the stages of shock?
A-2
b-3
c-14
d-6
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
What do we do for shock Assessment?
8
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
What is SIRS?
triggers 4
Systemic inflam response syndrome Triggered by infection, ischemia, infarction, and injury
What is SIRS criteria 6
Temp greater than 101 or less than 96.8
HR >90
RR>20
WBC>12,000 or <4,000
Altered Mental status
HIgh BG
How is SEPSIS measured
2 SIRS criteria and suspicion of infection
What are the stages of sepsis
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
What is the sepsis bundle?
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
MAP equation
Normal?
CVP
MAP=2xDBP+SBP/3
Normal 70 to 100
CVP-8-12
What is MODS
5
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
What systems do we watch for with MODS
9
respiratory, Cardiovascular, neuro, GI/GU, Metabolic Changes, coag problems-DIC, Acidosis, electrolyte issues. insulin issues and BG
Describe the different stages of shock:
Compensatory
Progressive
Irreversible (Refractory)
(What is going on in each? What will we see symptoms wise?)
MEgans
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
Most Common cause of SIRS
Bacteria
tx prevent infection
4 goals of fluid
CVP 8-12, MAP >65, UOP 0.5ml/kg/hr, normal lactate level
What are causes of SIRS?
MI, trauma, burns, pancreatitis, clots, infection= bacteria, fungi, viruses
