Sepsis Flashcards
Staphylococcus
Gram N rods
pseudomonas
Proinflammatory and procoagulant response in response to an infection
- increassed tnf alpha, interleuking 1beta
- upregulation of adhesion molecules on neutrophils and endothelial cells
- increased permeability due to inc Nitrious Oxide
- coagulation cascade activate: formation of microvasc thrombi
- protein C, S, Antithrombin are reuduced in sepsis, so reduceds anticoagulation
- decreased ciruculation can lead to anaerobic metabolism
what are the signs and symptoms of sepsis?
- CNS: altered mental status, confusion, septic encephalopathy
- Resp: tachypnea, hypoxia SaO2< 90%, hypoxemia PaO2<70, reduced preload
- Renal: oliguria, decreased urine output, inc creatinine
- Liver: inc LFTs and Tbili, decr albumin
- Hematologic: decr platelets, increast Pt/PTt
- Tissue hypoperfusion leading to increased lactate
what defines systemic inflammatory response syndrome? SIRS
- temperature less than 36 and more than 38
- HR more than 90
- RR more than 20 or PaCO2 < 32 or needs mechanical ventilation
- WBC > 12k or 10% immature forms
what defines sepsis?
- patient must have SIRS meetint 2 out of 4 of the criteria for SIRS.
- patient must have presumed or documented infection
what defines severe sepsis?
- patient must have sepsis.
2. patient must have signs of acute organ dysfunction
what defines septic shock?
- patient must have severe sepsis
- SBP<65 or SBP decreass more thant 40
- hypotension despite fluid reuscitation
what defines multiple organ dysfuncion syndrome? MODS?
fauilure of multiple organs requiring itnervention to maintain homeostasis.
what is the general treatment (whole) for sepsis?
- antibiotics
- fluids
- pressors/inotropes
- steroids
- glucose control
- supportive care: mechanical ventilation, sedation/analgesia, renal replacement therapy, nutrition, DVT & stress ulcer prophylaxis
how soon should you start antibiotics once you recognize that they have symptoms of severe sepsis or shock?
1 hour
how long should you take to have the person’s blood pressure under control?
6 hours
how long should it take you to have their glucose under control?
24 to 72 hours
what monitoring parameters should you monitor in sepsis?
- blood pressure: SBP, DBP, MAP or CVP
2. tissue hypoxia or hypoperfusion: central venous oxygen saturation, mixed venous oxygen hypoperfusion, lactate levels
what are your goals for CVP, MAP, UOP, ScvO2 for sepsis?
- CVP 8-12mmHg
- MAP>65
- UOP > 0.5ml/kg/hr
- ScvO2 >70%, mixed venous >65%
which crystalloids and colloids can you use for fluid resuscitation in sepsis?
- crystalloids: Normal Saline, Lactates Ringer’s
2. colloids: albumin 4% and 5%
what is the blood pressure equation?
SVR X CO
