Sepsis 2 Flashcards
what is phase 2 of septic shock
- cold
- everything starts to die
- lose fluid, causes decreased BP
- lungs top working
- ACIDODIC
- hypodynamic
- fluid in lungs becomes ARDS
- hypoxia of organs leads to MODS
what are s/s of phase 2 of septic shock
- cold
- decreased BP
- pulse pressure decreased
- low diastolic
- dilated out
what is the treatment of septic shock
- antibiotics broad spectrum (aerobic and anaerobic)
- ie/rocephin and vancomycin
what do you need to watch for if pt in phase 2
- renal failure
- ARDS
ARDS vent settings
tidal volume: 500 mL rate: 8-10 O2: 100% PAP: 5-10 cm H2O PEEP: 5 cm H2O
treatment of ARDS
- vent
- diuretics (Lasix)
- antibiotics
- norepinephrine
- vasopressin
if PAP meets _____, you die
mean pressure
what happens in ARDS
- pulmonary edema
- worst pneumonia ever
- lungs fill with fluid
- hypoxemia even with 100% O2
- dyspnea
mortality rate of ARDS
50-60%
what is happening to the lungs in ARDS
- systemic inflammatory response
- alveolar capillary membrane is damaged
- reduced surfactant and lungs become stiff and non compliant
- become acidodic and cannot breathe (intubate and give O2 100%)
what do we want to happen to resolve ARDS
alveoli to expand and touch blood vessel, push H2O away
what does pt in ARDS look like
breathing fast
BP decreased
CO goes up
overall what is the problem with ARDS pt
do not have enough oxygen
all about oxygenation
describe MODS
multiple organ dysfunction
2 or more organs unable to function
widespread SIRS
what are the causes of MODS
infection, ischemia, trauma, reperfusion injury
what is reperfusion injury
when given oxygen, makes peroxide and damages blood vessels
**monitor blood gases and watch for major drop in O2 (reperfusion)
primary MODS
involves lungs (ARDS)
secondary MODS
organ damage r/t infection
s/s of initial SIRS
- temp higher than 38 or less than 36
- HR >90
- RR >20 or pCO2 <32
- WBC >1200 or <4000
s/s of SIRS as it progresses (late)
- decreased LOC
- resp depression
- diminished bowel sounds
- jaundice
- oliguria or anuria
- increased PAP or PAWP w/ decreased C.O.
treatment of MODS
- mechanical vent
- hemodynamic monitoring
- fluid resuscitation
- vasopressors
- serial lab values
- dialysis
- antimicrobials
normal pCO2 values
35-45
normal WBC
4,000-10,000
MODS and SIRS cause what
decreased cardiac output
70% of all infections come from
gram negative bacteria
sepsis protocol (complete w/in 3 hrs)
1) measure lactate level
2) obtain blood cultures (before antibiotics)
3) administer broad spectrum antibiotics
4) administer crystalloid or lactate
sepsis protocol (complete w/in 6 hrs)
5) vasopressors
6) maintain MAP >65
- measure CVP and ScvO2
7) measure lactate if initial was increased
quantitiative rescusciation guidelines
CVP 8 mmHg
ScVO2 >70%
