Sepsis Flashcards
Whats severe sepsis? What is septic shock?
Septuc pts w/ evidence of organ hyperperfusion. Septic shock- when there is hypotension unresponsive to IV fluids.
SIRS requirments
2 or more of: Body temp >38 or 90/ min RespR >20 breaths per min or PaCo2 12x10 9 WCC >12 000 or
How would u manage SIRS? What are the therapeutic goals?
Systolic BP 3mmol/L ICU help 1. CVP : 8-12mmHg 2. Mean arterial pressure : >65mmHg 3. Urine output: 0.5mL/kg/hr 4. Central cenous saturation >65%
What approach would u follow?
ICU assistance now, ABC !- high flow oxygen, secure good IV access, Give IV bolus 20mL/kg of 0.9% saline. May: trachea, intubation. Look for infection sources Check BMG- bedsite venous/capilary blood glucose- treat if hypolglycaemic. Blood cultures before giving antibiotics
What happens if pt still hypotensive? Or lactate >3mmol/L ?
Require central venous and arterial catheterisation + IVI noradrenaline to maintain MAP >65mmHg And IV 0.9% saline every 20mins to maintain CVP 8-12mmHg (12-15mmHg in mechanicaly ventilated pts)
What is Shock? How is it recognised?
Failure to adequately perfuse and oxygenate vital organs. 1. Hypotension- systolic 100/min 2. Altered consciousness +\or fainting esp on standing- may be ⬇️ cerebral perfusion. 3. Poor peripheral perfusion- cool peripheries, sweaty skin, pallor, ⬇️ capillary refill, 4. Oliguria : ⬇️ renal perfusion w/ UO Low BP, rapid HR, sx of end organ perfusion- ⬇️ urine output, confusion, loss of consciousness.
When would a shocked pts not be tachycardic?
If he is taking b blockers or has a cardiac or neurological problem.
Whats hypovolaemic shock?
- Blood loss: trauma, GI bleed (haematemesis, melaena) , ruptured AA, ruptured ectopic pregn. 2. Fluid loss/redistribution: burns, GI loses; vomitting, diarrhoea, pancreatitis, sepsis.
Cardiogenic shock- causes?
Primary: MI, arrythmias, valve dysfunction, myocardiris. Secondary: cardiac tamponade, massive PE, tension pneumotharax.
Septic shock- what is it?
Extremes of age, DM, renal/hepatic F, and the immunocompromised- HIV, malignancy, post- splenectomy, steroid therapy. Fever, rigors, ⬆️WCC may not be present.
What organisms are responsible for septic shock?
Gram +ve & gram -ve: Staph. Aureus, strep. Pneumoniae, N meningitidis, enterococci + bacteroids In immunocompromised pts: pseudomonas, viruses & fungi.
What is neurogenic shock caused by? What hapoens? How do we manage it?
Spinal injury- Monitor ECG & BP. Interuption of sympathetic system in cord–> loss of vasomotor tone–> vasodilatation –> ⬆️ venous pooling + ⬇️ BP. IV fluids for hypotension and inotropes if CO ⬇️.
How do you prevent fluid overload?
CVP monitoring.
Other causes of shock
Poisoning, Addisons disease.
How do you manage shock?
ABC- high flow O2 mask + good IV access. Bloods: FBC, U&E, Glucose, LFTs, lactate, coagulation screen + if needed, blood cultures. Monitor vitals- BP, SpO2, resp rate. Check ABGs Monitor ECG + 12 lead ECG + CXR Inesert urinary catheter + monitor UO. If circ. IV crystalloid (0.9% saline) . Further colloid +_ blood. Look for: echo, USS, CT, -+ surgical interv. Treat the cause.
How would you treat?
Laparotomy- AAA, slpenic or liver trauma, ruptured ectopic, intra abdo sepsis. Angioplasty- MI Thrombolysis: PE Pericardiocentisis/ cardiac surgery: cardiac tamponade, aortic valve dysfunction. Antidotes: poisoning. Antibiotics: sepsis, co-amoxiclav + gentamicin+ metronidiazole. Inotropic + vasoactive therapy- + assisted ventilation…
What is SIRS?
Septic pts have a systemic inflammatory response syndrome, due to infection.
How would you manage a shocked patient?
ABC Secure airway- intubation- decrease work of breathing and guard for resp arrest. Oxygen supplementation, IV dluids, passive lef raising Blood transfusions if blood loss severe. Imp to keep person warm, manage pain + anxiety as they increase O2 consumption. Fluids: aggressive IV (1-2L of normal saline 0.9% bolus over 10-20 mins) kid-20ml/kg. crystalloids- less expensive. If still shocked- packed RBCs to keep Hb> 100gms.
How would you manage Haemorrhagic shock?
IV fluids limited- penetrating thorax or abdomen injuries. Allow mild hypotension- “permissive hypotension” Target: mean arterial pressure 60mmHg, A systolic BP 70-90mmHg.
What medications can be used if BP still persisting to be low?
Vasopressors- not effective for haemorrhagic shock or trauma. Used in neurogenic shock. Activated protein C or sodium bicarbonate- no effects on outcome…
What are the treatment goals when managing shock?
To achive a urine output of greater than 0.5ml/kg/hr A central venous pressure of 8-12mmHg In trauma- goal is to stop bleeding- might require surgical intervention.
