Sepsis 2

Question 1

what is phase 2 of septic shock

Answer 1

• 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

Question 2

what are s/s of phase 2 of septic shock

Answer 2

• cold
• decreased BP
• pulse pressure decreased
• low diastolic
• dilated out

Question 3

what is the treatment of septic shock

Answer 3

• antibiotics broad spectrum (aerobic and anaerobic)

- ie/rocephin and vancomycin

Question 4

what do you need to watch for if pt in phase 2

Answer 4

• renal failure

- ARDS

Question 5

ARDS vent settings

Answer 5

tidal volume: 500 mL
rate: 8-10
O2: 100%
PAP: 5-10 cm H2O
PEEP: 5 cm H2O

Question 6

treatment of ARDS

Answer 6

• vent
• diuretics (Lasix)
• antibiotics
• norepinephrine
• vasopressin

Question 7

if PAP meets _____, you die

Answer 7

mean pressure

Question 8

what happens in ARDS

Answer 8

• pulmonary edema
• worst pneumonia ever
• lungs fill with fluid
• hypoxemia even with 100% O2
• dyspnea

Question 9

mortality rate of ARDS

Answer 9

50-60%

Question 10

what is happening to the lungs in ARDS

Answer 10

• 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%)

Question 11

what do we want to happen to resolve ARDS

Answer 11

alveoli to expand and touch blood vessel, push H2O away

Question 12

what does pt in ARDS look like

Answer 12

breathing fast
BP decreased
CO goes up

Question 13

overall what is the problem with ARDS pt

Answer 13

do not have enough oxygen

all about oxygenation

Question 14

describe MODS

Answer 14

multiple organ dysfunction
2 or more organs unable to function
widespread SIRS

Question 15

what are the causes of MODS

Answer 15

infection, ischemia, trauma, reperfusion injury

Question 16

what is reperfusion injury

Answer 16

when given oxygen, makes peroxide and damages blood vessels

**monitor blood gases and watch for major drop in O2 (reperfusion)

Question 17

primary MODS

Answer 17

involves lungs (ARDS)

Question 18

secondary MODS

Answer 18

organ damage r/t infection

Question 19

s/s of initial SIRS

Answer 19

• temp higher than 38 or less than 36
• HR >90
• RR >20 or pCO2 <32
• WBC >1200 or <4000

Question 20

s/s of SIRS as it progresses (late)

Answer 20

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

Question 21

treatment of MODS

Answer 21

• mechanical vent
• hemodynamic monitoring
• fluid resuscitation
• vasopressors
• serial lab values
• dialysis
• antimicrobials

Question 22

normal pCO2 values

Answer 22

35-45

Question 23

normal WBC

Answer 23

4,000-10,000

Question 24

MODS and SIRS cause what

Answer 24

decreased cardiac output

Question 25

70% of all infections come from

Answer 25

gram negative bacteria

Question 26

sepsis protocol (complete w/in 3 hrs)

Answer 26

1) measure lactate level
2) obtain blood cultures (before antibiotics)
3) administer broad spectrum antibiotics
4) administer crystalloid or lactate

Question 27

sepsis protocol (complete w/in 6 hrs)

Answer 27

5) vasopressors
6) maintain MAP >65
- measure CVP and ScvO2
7) measure lactate if initial was increased

Question 28

quantitiative rescusciation guidelines

Answer 28

CVP 8 mmHg

ScVO2 >70%