Sepsis 2 Flashcards
describe phase 2 of septic shock
- COLD
- everything starts to die
- lose fluid, causes BP to decrease
- fluid fills up in lungs… lead to ARDS and stop working
- ACIDIC
s/s of phase 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
this has a high mortality and can occur during phase 2
ARDS (adult resp distress syndrome)
high mortality
treatment of septic shock
**Antibiotics (a lot)
aerobic and anaerobic
broad spectrum
ie/ Rocephin, vancomycin
what do you need to watch for if pt is in septic shock
renal failure and ARDS
ARDS vent settings
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
what does ac mean
assist control
what is PA pressure normally
20/10 w/ mean of 20
if PAP meets _____ ____ you die
mean pressure
describe ARDS
- pulmonary edema
- worse pneumonia ever
- lungs fill w/ fluid
- hypoxemia even w/ 100% O2
- dyspnea
- systemic inflammatory response
what is mortality rate of ARDS
50-60 %
what is damaged in ARDS
alveolar capillary membrane
what is reduced in ARDS
decreased surfactant and lungs therefore become stiff and non compliant
become acidodic and cannot breathe
what do you do if pt in ARDS
- intubate and give 100% O2
drugs: diuretics (Lasix), antibiotics, norepinephrine, vasopressin
goal of pt in ARDS
alveoli to expand and touch blood vessel to push H2O away
treatment of ARDS
go on vent, antibiotics, diuretics
overall what is wrong with ARDS pt
does not have enough O2, all about oxygenation
what does pt in ARDS look like
breathing fast, BP decreased, CO2 goes up
describe MODS
multiple organ dysfunction
>2 organs unable to function
widespread systemic inflammation (SIRS)
primary MODS involves…
lungs (ARDS)
secondary MODS involves…
organ damage r/t infection
what are the causes of MODS
infection, ischemia, trauma, reperfusion injury
what is reperfusion injury
when given O2, makes peroxide instead and damages blood vessels
*monitor Blood Gases and watch for major drop in O2 (reperfusion)
signs of MODS
temp higher than 38 or <36
HR >90
RR >20
WBC >12,000 or <4,000
as SIRS progresses what happens
- decreased LOC
- resp depression
- diminished bowl sounds
- jaundice
- oliguria
- increased PAP or PAWP w/ decreased C.O.
treatment of MODS
mechanical ventilation hemodynamic monitoring fluid resuscitation vasopressors serial lab values dialysis antimicrobials
MODS and SIRS causes decreased ________
cardiac output
70% of all infections come from _____
gram negative bacteria
normal WBC
4,000-10,000
normal pCO2
35-45
why can a low temp be bad
can go into cold shock (can be just as bad as high temp)
