Sepsis Recap Flashcards
Define SIRS
Systemic inflammatory response syndrome.
Widespread inflammatory response to an infectious or non-infectious insult
Define sepsis (old def)
SIRS + documented or suspected infection
Define sepsis (new def)
life-threatening organ dysfunction caused by a dysregulated host response to infection.
Organ dysfunction is defined as SOFA (or q SOFA) score >/= 2
Define severe sepsis (old def)
Sepsis + evidence of organ dysfunction
Define severe sepsis (new def)
No such thing! All sepsis is “severe” now.
Define septic shock (old def)
Sepsis + hypotension that is not responsive to fluid therapy
Define septic shock (new def)
- a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone.
Vasopressors required to maintain MAP >65
AND
Lactate >2 in the absence of hypovolemia
Define MODS
multiple organ dysfunction syndrome.
Sepsis/SIRS + more than one organ dysfunction.
Increase in SOFA score of >/= 2 points.
What are the components of a SOFA score?
- Respiration: based on PaO2/FiO2 ratio
- Coagulation: based on platelet count
- Liver: based on bilirubin
- Cardiovascular: based on MAP
- CNS: based on Glasgow coma scale
- Renal: based on creatinine and urine output
What are the components of a qSOFA score?
3 categories not requiring lab work, score 0 or 1
RR >22/min
Altered mentation
Systolic BP <100mmHg
List 8 other findings of organ dysfunction with sepsis/SIRS that are not accounted for with a SOFA score.
- Hyperglycemia
- Hypoglycemia
- GI signs (V/D)
- Cardiac dysfunction (arrhythmias, impaired contractility)
- Immune dysregulation (CARS)
- Mitochondrial dysfunction
- Vascular leak/increased vascular permeability
- Hypoalbuminemia
What are the 4 basic steps in sepsis treatment?
- Identification
- Administer broad spectrum antibiotics (within 1 hr of ID)
- Systemic Stabilization
- Source Control
List the 5 major catecholamine receptors.
α1
α2
β1
β2:
dopaminergic (D receptors)
What are the effects of stimulation of alpha 1 (α1) receptors?
vasoconstriction (arterial and venous)
mild positive inotrope
What are the effects of stimulation of alpha 2 (α2) receptors?
primarily vasoconstriction, but vasodilation of vital organs
What are the effects of stimulation of beta 1 (β1) receptors?
Positive inotrope and chronotrope
What are the effects of stimulation of beta 2 (β2) receptors?
Vasodilation of vital organs
Bronchodilation
What are the effects of stimulation of Dopaminergic (D) receptors?
vasodilation of smooth muscle (renal, splanchnic, coronary, cerebrovascular).
What are the primary receptors stimulated by norepinephrine?
Primarily α
mild β (increases SVR)
What are the primary receptors stimulated by epinephrine?
Non selective α and β
What are the primary receptors stimulated by Dopamine?
Low dose (1-5mcg/kg/min): dopaminergic receptors
Mid dose (5-10): primarily β1, some α (positive inotrope/chronotrope with mild increase in SVR)
High dose (10-20): primarily α1 (vasoconstriction), lower GI blood flow
What are the primary receptors stimulated by dobutamine?
Beta only (β 1 > β 2)
What are the primary receptors stimulated by vasopressin?
V1: vasoconstriction
V2: found in the renal collecting duct, increases water reabsorption (increases aquaporin channels in the duct)
V3: stimulate release of ACTH from the pituitary
According to the Surviving Sepsis Guidelines, what is the preferred vasopressor for septic shock?
List the other options in order of preference.
- Norepinephrine
- Epinephrine
- Vasopressin
- Dopamine
- Phenylephrine- not really recommended at all anymore