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Complex > Sepsis 3 > Flashcards

Sepsis 3 Flashcards

1
Q

Sepsis Guidelines: First 3 hrs in ED

A

1) Start an IV (1 or 2) and draw blood
2) Check O2 via pulse Ox, give 2-4 L of O2
3) Get them on EKG/monitor & Vitals
4) Get a culture from sputum and blood
Need Physician order for:
5) Antibiotics: Vancomycin, Levoquin, Flagyl, Rocephin
6) Normal Saline Solution (2-3 L), want MAP >65 and CVP 8-12
7) Foley to measure urine output
8) CXR or CT (diagnostic test)

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2
Q

Sepsis Guidelines: >6 Hrs (ICU)

A

1) Put in a hemodynamic catheter (precep Cath: monitors CVP, SCVO2, cardiac output)
2) ART line: give BP and way to draw blood
3) Draw more blood: lactate level, CRP, D dimer (see whats going on), platelet counts
4) Intubate and give PAP or PEEP (increase pressure) PRONE them (turn regardless every 2 hrs)
5) Sedate (precede aka dexmethetomadate)
6) Give Diuretic (Lasix) & Antibiotics for ARDS
7) Give vasopressor (Norepi and vasopressin) for DIC** and heparin for platelets/FFP
8) Nutrition (enteral feedings, glucose control (insulin drip), dialysis (CRRT), Reglan IV
9) Lovenox (to prevent DVT)

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3
Q

normal pCO2

A

35-45

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4
Q

HCO3

A

22-26

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5
Q

paO2

A

80-100

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6
Q

ScVO2

A

70-80

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7
Q

first phase of septic shock

A

warm: hyperdynamic

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8
Q

s/s of warm first phase of septic shock

A 
Increased C.O.
Peripheral vasodilation
Decreased SVR
Change LOC
Rapid, shallow breathing
Decreased urine output
Rapid, bounding pulse
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9
Q

second phase of septic shock

A 
Decreased C.O.
Vasoconstriction
Increased SVR
Inadequate tissue perfusion
Pale, cyanotic
Mottling extremities
Absent urine output
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10
Q

treatment of septic shock

A

*find the cause of infection (do whole panel of lab work and blood cultures (2 cultures: 1) aerobic and THEN 2) anaerobic)
Remove source of infection
Aggressive antibiotics
Vasopressors with Epinephrine or Norepi and Vasopressin
Mechanical ventilation
Sedation- BIS sedation monitor

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11
Q

when do you give antibiotics and fluids if septic shock

A

before cultures even come back (if suspected/criteria)

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12
Q

what are blood cultures checking for

A

checking for sepsis: has infection gone from the site of origin to generalized blood stream??

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13
Q

what is often the first indication of DIC

A

petechiae

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14
Q

sepsis is the _____ most
common principal reason for
hospitalization in the U.S. with

A

6th

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15
Q

what is sepsis

A

Way the immune system responds to infection

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16
Q

what can DIC lead to

A

Become gangrenous and clot off (cause perfusion, lose peripherals/limbs)

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17
Q

6 Steps of Sepsis Protocol: separated into 6 hr time frame

A

1) High Flow oxygen
2) blood cultures
3) IV antibiotics
4) IV fluid resuscitation (crystalloids)
5) measure lactate
6) measure urine output and strict fluid balance

18
Q

during the first 6 hours of sepsis what are the goals

A

1) Oxygen, lab work, etc
2) **GOAL keep CVP up (8-12) and want BP to be good so give 2-3 L of saline
3) Give oxygen at 4 L
4) Systemic venous oxygenation: want 70-80

19
Q

goals of initial resuscitation

A

a) CVP 8–12 mm Hg
b) MAP ≥ 65 mm Hg
c) Urine output ≥ 0.5 mL/kg/hr
d) Scvo2 ≥ 70%. Systemic venous oxygenation (still being delivered to organs in body)

20
Q

what is a presep sepsis catheter

A

short line, goes in like a swan and measures venous oxygenation and ScvO2

21
Q

what are crystalloids

A

saline

22
Q

Sepsis and septic shock are ___________

A

medical emergencies

23
Q

first steps in sepsis diagnosis

A

Identify SOURCE: use blood cultures, wound, sputum

Start antibiotics IMMEDIATELY before culture comes back

24
Q

what meds are recommended for sepsis (priority)

A

combination antibiotics-broad spectrum (usually at least two, anaerobic and aerobic)

25
Q

what vasoactive agents are given

A

Norepi because it vasoconstricts and pushes fluid INTO heart and keeps BP up
Add vasopressin next because it stops bleeding (if DIC) and natural ADH

26
Q

if shock is not resolving quickly…

A

further hemodynamic assessment (such as assessing cardiac function) to determine the type of shock

27
Q

what can help guide resuscitation

A

normalizing lactate levels

28
Q

frequent assessment of _____ is crucial during resuscitation period.

A

patients volume status

29
Q

who is often the screening system for sepsis in the hospital setting

A

nurses

30
Q

does sepsis require reporting

A

yes mandated public reporting

31
Q

what drugs are not recommended for sepsis and why

A

Against using corticosteroids- goes against fighting infection

32
Q

what position should a pt in sepsis (and specifically ARDS*) be in?

A
  • *PRONE positioning: turn patient on their stomach!!
  • TURN PT EVERY TWO HOURS regardless
  • put sheets over them, and turn onto stomach (bring all junk out of lungs)
  • prone allows full expansion of lungs: do it once a shift ( leave them for 4 hrs)
33
Q

We suggest using ___________ in adult patients with sepsis-induced ARDS.

A

higher PEEP over lower PEEP

34
Q

what type of tidal volume should be used with ARDS pt

A

lower tidal volume to prevent lung capacity damage

35
Q

what needs to be monitored hourly in sepsis pt

A

Control blood sugars (hourly glucose monitoring )
Acucheck every hour (can go up to 120, try to keep below that)
Want glucose in system to fight infection! –put pt on insulin drip

36
Q

Always have_____ in sepsis pt as it is the best way to draw blood

A

art line

37
Q

why is reglan given

A

to keep the stomach empty

38
Q

why is NG given

A

to keep stomach decompressed and prevent them from vomiting

39
Q

complete within 3 hrs

A

1) Measure lactate level
2) Obtain blood cultures prior to administration of antibiotics
3) Administer broad spectrum antibiotics
4) Administer 30 mL/kg crystalloid for hypotension or lactate 4mmol/L

40
Q

complete within 6 hrs

A

5) Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation)
to maintain a mean arterial pressure (MAP) 65 mm Hg
6) In the event of persistent arterial hypotension despite volume resuscitation (septic
shock) or initial lactate 4 mmol/L (36 mg/dL):
- Measure central venous pressure (CVP)*
- Measure central venous oxygen saturation (ScvO2)*
7) Remeasure lactate if initial lactate was elevated*
*Targets for quantitative resuscitation included in the guidelines are CVP of 8 mm Hg, scVo2 > 70%

Complex (38 decks)

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