Sepsis and shock

Question 1

Definition of shock

Answer 1

Systemic failure of ATP production

Question 2

Four types of shock

Answer 2

Hypovolaemic
Distributive
Cardiogenic
Obstructive

Question 3

Mechanism of hypovolaemic shock

Answer 3

Decreased blood volume

E.g. Haemorrhage, severe dehydration

Question 4

Mechanism of distributive shock

Answer 4

Vasodilation, unable to vasoconstrict appropriately, innappropriate pooling of circulating blood

E.g. sepsis, SIRS, anaphylaxis

Question 5

Mechanism of cardiogenic shock

Answer 5

Failure of forward flow

E.g. systolic failure (reduced contractiliy), diastolic failure (reduced filling), dysrhythmias

Question 6

Mechanism of obstructive shock

Answer 6

Mechanical obstruction of venous return

E.g. pericardial effusion, GDV

Question 7

Types of circulatory shock

Answer 7

Compensated
Non-compensated

Question 8

Compensated shock

Answer 8

Catecholamine release induces physiological responses to maintain delivery of oxygen to tissues.

Question 9

Clinical signs of mild shock in dogs

Answer 9

HR: 130-150
MM colour: normal to pinker
CRT: rapid <1s
Pulse amplitude: increased
Pulse duration: mildly reduced
Metatarsal pulse: easily palpable

Question 10

Clinical signs of moderate shock

Answer 10

HR: 150-170
MM: pale pink
CRT: Approx normal
Pulse amplitude: mild to moderate decrease
Pulse duration: Moderately reduced
Metatarsal pulse: just palpable

Question 11

Clinical signs of severe shock

Answer 11

HR: 170-220
MM: grey, white, or muddy
CRT: slow (>2s) or absent
Pulse amplitude: severe decrease
Pulse duration: severely reduced
Metatarsal pulse: absent

Mentation often affected - obtunded

Question 12

Shock in cats

Answer 12

Bradycardia and hypothermia

Question 13

Treatment of hypovolaemic shock

Answer 13

Bolus fluids

Question 14

Treatment of distributive shock

Answer 14

Bolus fluids
Vasopressors

Question 15

Treatment of cardiogenic shock

Answer 15

Treat underlying cause

Question 16

Treatment of obstructive shock

Answer 16

Relieve obstruction

Question 17

First choice fluids for shock

Answer 17

Isotonic crystalloid fluid e.g. Hartmann’s

Typical fluid bolus may be 10ml/kg given over 15 mins

Question 18

Parallel treatment to fluid bolus in shock patients

Answer 18

Oxygen supplementation
Fix underlying causes

Question 19

Bleeding patients

Answer 19

fluids will dilute clotting factors.

Fluids still can be lifesaving in the short term but in the long term they are likely to need a blood transfusion.

Question 20

Sepsis

Answer 20

Life-threatening systemic inflammation secondary to a dysregulated host response to infection

Question 21

Sepsis parameters in cats

Answer 21

Temp: <37.8 or >39.7
RR: >40
HR: <140 or >225
WBC: <5103/μL or >19.5103/μL

Can be diagnosed if 2/4 are met

Question 22

Sepsis parameters in dogs

Answer 22

Temp:
<37.2°C
>39.2°C

RR: >30 bpm

HR: >140 bpm

WBC:
<6103/μL
>19103/μL
>3% bands

3/4 parameters have to be met

Question 23

Hallmark of systemic inflammation

Answer 23

Cytokine mediated inappropriate vasodilation

Question 24

If source of infection not found which broad spectrum antibiotic shoudl you start with

Answer 24

Potentiated amoxicillin 20mg/kg 3x daily

Question 25

Fluid therapy in septic patients in distributive shock

Answer 25

May respond to fluid resuscitation, but vasopressor therapy may be required to treat the inappropriate vasodilation e.g. norepinephrine

Question 26

Vasopressor drugs

Answer 26

Norepinephrine Dopamine Dobutamine

Question 27

Norepinephrine

Answer 27

Mild increase in cardiac contractility Marked increase in vasomotor tone Dose 0.1-2mcg/kg/min

Question 28

Dopamine

Answer 28

Moderate increase in cardiac contractility Moderate increase in vasomotor tone Dose: 5-15 mcg/kg/min

Question 29

Dobutamine

Answer 29

Moderate increase in cardiac contractility Moderate increase in vasomotor tone Dose: 5-20 mcg/kg/min

Question 30

What endocrine imbalance is common in sepsis

Answer 30

Profound hypoglycaemia Blood glucose should be measured at presentation and again if patient deteriorates Can give diluted dextrose (1:3) IV in needed, and dextrose in fluids