Sepsis 2

Question 1

describe phase 2 of septic shock

Answer 1

• COLD
• everything starts to die
• lose fluid, causes BP to decrease
• fluid fills up in lungs… lead to ARDS and stop working
• ACIDIC

Question 2

s/s of phase 2

Answer 2

• cold, decrease in BP, decrease in pulse pressure, low diastolic, dialated out
• DIC develops, pt is confused/lethargic
• hypoxia to organs leads to MODS

Question 3

this has a high mortality and can occur during phase 2

Answer 3

ARDS (adult resp distress syndrome)

high mortality

Question 4

treatment of septic shock

Answer 4

**Antibiotics (a lot)
aerobic and anaerobic
broad spectrum
ie/ Rocephin, vancomycin

Question 5

what do you need to watch for if pt is in septic shock

Answer 5

renal failure and ARDS

Question 6

ARDS vent settings

Answer 6

total volume: 500 mL (any more than this will hurt heart)
rate: 8-10
O2: 100%
PAP: 5-10 cm H2O
PEEP: 5 cm H2O

Question 7

what does ac mean

Answer 7

assist control

Question 8

what is PA pressure normally

Answer 8

20/10 w/ mean of 20

Question 9

if PAP meets _____ ____ you die

Answer 9

mean pressure

Question 10

describe ARDS

Answer 10

• pulmonary edema
• worse pneumonia ever
• lungs fill w/ fluid
• hypoxemia even w/ 100% O2
• dyspnea
• systemic inflammatory response

Question 11

what is mortality rate of ARDS

Answer 11

50-60 %

Question 12

what is damaged in ARDS

Answer 12

alveolar capillary membrane

Question 13

what is reduced in ARDS

Answer 13

decreased surfactant and lungs therefore become stiff and non compliant
become acidodic and cannot breathe

Question 14

what do you do if pt in ARDS

Answer 14

• intubate and give 100% O2

drugs: diuretics (Lasix), antibiotics, norepinephrine, vasopressin

Question 15

goal of pt in ARDS

Answer 15

alveoli to expand and touch blood vessel to push H2O away

Question 16

treatment of ARDS

Answer 16

go on vent, antibiotics, diuretics

Question 17

overall what is wrong with ARDS pt

Answer 17

does not have enough O2, all about oxygenation

Question 18

what does pt in ARDS look like

Answer 18

breathing fast, BP decreased, CO2 goes up

Question 19

describe MODS

Answer 19

multiple organ dysfunction
>2 organs unable to function
widespread systemic inflammation (SIRS)

Question 20

primary MODS involves…

Answer 20

lungs (ARDS)

Question 21

secondary MODS involves…

Answer 21

organ damage r/t infection

Question 22

what are the causes of MODS

Answer 22

infection, ischemia, trauma, reperfusion injury

Question 23

what is reperfusion injury

Answer 23

when given O2, makes peroxide instead and damages blood vessels
*monitor Blood Gases and watch for major drop in O2 (reperfusion)

Question 24

signs of MODS

Answer 24

temp higher than 38 or <36
HR >90
RR >20
WBC >12,000 or <4,000

Question 25

as SIRS progresses what happens

Answer 25

• decreased LOC
• resp depression
• diminished bowl sounds
• jaundice
• oliguria
• increased PAP or PAWP w/ decreased C.O.

Question 26

treatment of MODS

Answer 26

mechanical ventilation
hemodynamic monitoring
fluid resuscitation
vasopressors
serial lab values
dialysis
antimicrobials

Question 27

MODS and SIRS causes decreased ________

Answer 27

cardiac output

Question 28

70% of all infections come from _____

Answer 28

gram negative bacteria

Question 29

normal WBC

Answer 29

4,000-10,000

Question 30

normal pCO2

Answer 30

35-45

Question 31

why can a low temp be bad

Answer 31

can go into cold shock (can be just as bad as high temp)