Sepsis and Shock Flashcards
3 types of Shock
Hypovolemic
Cardiogenic
Distributive (vasodilatory)
Shock
Physiologic state characterized by significant reduction of systemic tissue perfusion
– Systemic tissue perfusion is determined by cardiac output (CO) and systemic vascular resistance (SVR)
• CO=HR+SV
• SVR = MAP /CO and is determined by vessel length, blood viscosity and vessel diameter
Decreased preload secondary to intravascular volume loss resulting in decreased CO and a compensatory increase in SVR
-Can be hemorrhage or fluid loss induced
Hypovolemic Shock
Decreased CO secondary to cardiac pump failure SVR is increased to maintain perfusion Categories: – Cardiomyopathy – Arrhythmia – Mechanical abnormality – Extracardiac abnormality
Cardiogenic Shock
Hallmark is a decreased SVR CO increased in an effort to compensate Many causes: – Septic shock – SIRS – Toxic shock syndrome – Anaphylactic shock – Neurogenic shock
Distributive (Vasodilatory) Shock
Systemic Inflammatory Response Syndrome (SIRS) Criteria
More than 2 of the following: HR >90 Temp >38 (100.4F) or less than 36 PaCO2 less than 32 RR >20 WBC > 12000 or less than 4000 or > 10% bands
Sepsis
SIRS secondary to infection
Severe sepsis
sepsis associated with organ dysfunction,
hypoperfusion, or hypotension. May include lactic
acidosis, oliguria or acute alteration in mental status
Septic Shock
sepsis with hypotension, despite fluid resuscitation, along with the presence of perfusion abnormalities
Multiple organ dysfunction syndrome (MODS)
presence of altered organ function requiring intervention to maintain homeostasis
Early sepsis
(first 6 hrs): Fever/hypothermia Chills Mental status changes Tachycardia Tachypnea, hypoxia
Late sepsis
>6 hours: lactic acidosis oliguria DIC Hypotension (shock)
Goals of sepsis tx within first 6 hours
MAP >65
Urine output >0.5 ml/kg/hr
O2 sat >70%
Central venous pressure 8-12
