Sepsis and shock

Question 1

definition of shock

Answer 1

imbalance between oxygen demand and supply

Question 2

types of shock 4

Answer 2

cardiogenic
obstructive
hypovolemic
distributive

Question 3

types of distributive shock 3

Answer 3

anaphylactic
septic
neurogenic

Question 4

hypotension in shock

Answer 4

widespread vasodilation/lack of cardiac output/lack of circulating volume

Question 5

tachycardia in shock

Answer 5

compensatory mechanism to increase cardiac output

Question 6

increased respiratory rate in shock

Answer 6

increased lactic acid due to anaerobic respiration causes decreased blood pH therefore respiratory rate increases to remove CO2 from the blood stream.

Question 7

pallor in shock

Answer 7

due to peripheral vasoconstriction and sympathetic activity to divert blood flow to vital organs

Question 8

cyanosis

Answer 8

due to lack of oxygenated blood flow

Question 9

oliguria in shock

Answer 9

decreased renal blood flow upregulates the renin-angiotensin system to increase aldosterone levels. this increases water and salt reabsorption to restore blood volume and pressure but reduces urine output.

Question 10

altered mental status / level of consciousness

Answer 10

reduction in oxygenated blood flow to cerebral tissue causes neurological deficits and reduced level of consciousness

Question 11

septicaemia

Answer 11

presence of large amounts of infective material in the circulating blood stream

Question 12

sepsis

Answer 12

symptoms caused by septicaemia - life threatening organ dysfunction caused by dysregulated host response to infection

Question 13

DIC in sepsis

Answer 13

As lytic enzymes and oxygen species breakdown vessel walls, coagulation factors are recruited to prevent bleeding however eventually demand is too high so simultaneous bleeding and coagulation occurs

Question 14

ARDS in sepsis

Answer 14

acute respiratory distress syndrome due to damage to pulmonary blood vessels impeding on gas exchange

Question 15

Cardiac function in sepsis

Answer 15

cardiac output initially increases with tachycardia to compensate for vasodilation and decreased BP but eventually sepsis impairs cardiac function and cardiac muscle is exhausted and so cardiac output decreases

Question 16

skin temperature in sepsis

Answer 16

initially warm as blood flow directed to large organs but as peripheral vasoconstriction and sympathetic activity occur blood flow is diverted to vital core organs so skin feels cold

Question 17

stages of sepsis

Answer 17

1) infective material enters the blood stream
2) mass recruitment of white blood cells including mast cells and neutrophils
3) histamine and other mediator release causes widespread vasodilation and increased permeability
4)blood pressure decreases and fluid builds up in interstitial spaces reducing diffusion of oxygen and removal of waste products.
5) perfusion decreases to a point where oxygen demand cannot be met.

Question 18

indicators of sepsis

Answer 18

recent infection
fever
low blood pressure
rash
low urine output
tachycardia (early)
bradycardia (late)
NEWS2 of 5+

Question 19

red flag sepsis ADULTS

Answer 19

responds to pain/voice only
systolic under 90
heart rate over 130
respiratory rate over 25
non blanching rash
no urine in last 18 hrs
recent chemotherapy
needs Oxygen for spO2 over 92%