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
what is the Cardiac output equation?
HR x SV
which possible pressors should you use to increase blood pressure?
- NE *
- DA*
- Epi
- Phenyleph
- Vasopressin
Order of choice above
NE and DA have most evidence. DA more SEs
vasopressin can be added to NE
what is the rationale that people use to justify the use of steroids in sepsis?
decrease synthesis of iNOS leading to vasodilation
increased sensitivity of vascular catecholamine receptors
decreased transcritpon of inflammatory cytokines
which corticosteroid can you give and what dose?
hydrocortisone less that or equal to 300mg per day
when treating hyperglycemia from sepsis , when should you start therapy and what is your goal approximately?
when blood sugar is >180mg/dl
Goal: ~150mg/dl
which medication should you use to control hyperglycemia in sepsis?
IV insulin
