Sepsis and Shock HYHO Flashcards
How do you define organ dysfunction in sepsis?
qSOFA: can be completed bedside with no labs
SOFA: Needs labs.
Sepsis defined as score >2 above baseline.
Discuss the current definition of sepsis and septic shock
Sepsis is broadly defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection.
Septic shock is broadly defined as a subset of septic patients in which circulatory and cellular metabolism abnormalities are profound and substantially increase the risk of hospital mortality.
Clinically, septic shock is sepsis with persisting hypotension requiring vasopressors to maintain MAP >65 mmHg and having a serum lactate >2 mmol/L despite adequate volume resuscitation.
Discuss the prognosis for sepsis and septic shock
Sepsis: inpatient mortality >10%
Septic shock: inpatient mortality >40%
Discuss and apply the current sepsis algorithm for distinguishing between sepsis and septic shock
Sepsis with: despite adequate fluid resuscitation, 1. vasopressors required to maintain MAP >65 mm Hg AND 2. Serum lactate level >2 mmol/L
Equals septic shock
Discuss the Glasgow coma scale as it pertains to SOFA criteria
If SOFA>2= sepsis, glasgow coma scale score is a SOFA variable
Discuss clinical presentation and diagnostic evaluation of pts with sepsis or septic shock
All types of shock lead to hypotension, tachycardia, AMS, and oliguria.
Labs: CMP, CBC with dif, PT, PTT, fibrinogen, D-dimer, peripheral blood smear, ABG, serum lactate, plasma procalcitonin, identify source of infection
Discuss the complications of sepsis
DIC: thrombocytopenia, elevated PT and PTT levels, elevated D-dimer and fibrin degradation products, decreased fibrinogen levels, abnormal peripheral blood smear
Acute kidney injury
Acute hepatic injury
ARDS
What are the hour-1 bundle recommendations?
- Measure lactate level
- Obtain blood cultures prior to antibiotic administration
- Administer empiric broad-spectrum antibiotics
- Fluid resuscitation with IV fluids (at least 30 ml/kg) for hypotensive pts or lactate >4 (crystalloid fluids preferred)
- Add vasopressors in adequately volume resuscitated patients to maintain MAP >65
Norepinephrine is preferred vasopressor, can add vasopressin or epinephrine. Can add dobutamine.
Discuss the different types of vasopressors and their associated receptors and their role in sepsis treatment
(α-1, β1, β2, dopamine D1, vasopressin V1 and V2)
1) α-1: located in vascular smooth muscle, vasoconstriction
2) β-1: located mostly in heart, increases HR and cardiac contraction
3) β-2: located in vascular and bronchial smooth muscles, vasodilation and bronchodilation
4) Dopamine receptors (D1): located in renal and splanchnic vascular beds, vasodilation
5) Vasopressin receptors (V1 and V2)
V1 vascular smooth muscle, vasocontriction
V2 renal collecting duct, antidiuresis
What 6 systems are involved in the SOFA score?
Respiration, coagulation, liver, CV, CNS, Renal.
Variables include PaO2/FiO2 ratio, Glasgow coma scale, MAP, administration of vasopressors with type and dose rate of infusion, serum creatinine or urine output, bilirubin, platelet count
What PaO2:FiO2 ratio is needed to dx ARDS?
<300 mm Hg
What PaO2:FiO2 ratio is needed to dx ARDS?
<300 mm Hg
What is the initial treatment of sepsis? What do you need to do to ensure vascular access?
2 large bore peripheral IVs
Central line, typically a right internal jugular vein catheter
Arterial line
Urinary catheter (goal urine output is > 0.5 ml/kg/hr
Also consider endotracheal intubation if indicated
What is the initial treatment of sepsis? What do you need to do to ensure vascular access?
2 large bore peripheral IVs
Central line, typically a right internal jugular vein catheter
Arterial line
Urinary catheter (goal urine output is > 0.5 ml/kg/hr
Also consider endotracheal intubation if indicated
