Sepsis

Question 1

Sepsis definition

Answer 1

SIRS criteria from an infection
Severe is sepsis with organ dysfunction
Septic shock is sepsis with hypotension (<90 after fluid)

Question 2

SIRS criteria

Answer 2

Atleast 2 of the following:
Tachycardia
Tachypnea
Hypo or hyperthermia
Elevated/reduced WBC
Bandemia

Question 3

Bandemia

Answer 3

Excess of immature of band cells (immature WBCs)

Question 4

Risk factors for sepsis

Answer 4

Multiple comorbidities, geezers. Aids, chemo, steroid dependency and prosthetics and plastic (IV devices, ETTs, catheters)

Question 5

Vascular tone in sepsis

Answer 5

Surge then lowered vasopressin (other shocks remains elevated)
NO increases

Question 6

Vasopressin

Answer 6

Potent vasoconstriction with less cardiac effects.
V1 - vascular smooth muscle of systemic, splanhnic, renal and coronary circulation. Increases GFR
V2 - anti-diuresis. Induces release of von willebrand factor and factor VIII. Increases platelet aggregation.
V3 - Increases ACTH and therefor cortisol
OTR - oxytocin receptor subtypes in myometrium and vascular smooth muscle.
P2 - ?sumthin with smooth muscle and cardiac contractility

Less pulmonary vasoconstriction (possibly even pulmonary artery vasodilation)
Less arrhythmias
0.01-0.1 u/min (fast onset, fast offset for vascular long for kidneys)
Indications: DI, refractory shock, cardiac arrest (40U bolus), hemostasis in esophageal varices, hemophilia, von willibrands disease

Question 7

Septic encephalopathy

Answer 7

10-70% of septic pt’s experience neuro impairment. Could be from metabolic derangement, direct bacteria invasion, altered perfusion, etc.

Question 8

Sepsis cardiac function

Answer 8

Initial increased CO but with LV dilation and decreased EF. Dead or alive organisms inhibit cardiac function as does immune system. Aggressive fluid to increase preload and likely EF

Question 9

Sepsis respiratory

Answer 9

Inflammation causes increased airway resistance along with fatiguing muscles making respiratory function difficult (need more O2, produce more CO2, neither can be exchanged well)
Also creates R–>L shunt with resulting intractable arterial hypoxemia

Question 10

Endocrine sepsis

Answer 10

Adrenal insufficiency common because of inflammatory mediators increasing or decreasing release, as well as hypoperfused adrenal cortex and dysfunction of the pituitary secondary to sepsis