Sepsis & Shock Flashcards
Sepsis:
Systemic response to infection
Severe Sepsis:
Sepsis with organ dysfunction
Septic Shock:
Sepsis with marked hypotension despite adequate fluid resuscitation
SIRS
Widespread systemic inflammatory response
SIRS Triggers
-Microbial invasion: bacteria, viruses, fungi
-Endotoxin release: gram-negative bacteria
-Global perfusion deficits: post cardiac resuscitation, shock states
-Regional perfusion deficits: distal perfusion deficits
SIRS Associated disorders
Infection
Trauma
Shock
Pancreatitis
Ischemia
SIRS Criteria & S/S
-High Temperature 100.4 (38) or Low Temperature 96.8 (36)
-Heart Rate greater than 90bpm
-Respiratory Rate greater than 20
-WBC less than 4k or greater than 12k
-BG greater then 140 in non-diabetic patient
*Must meet 2 of these criteria and have a known source of infection to be septic
Initial Sepsis One hour bundle
Measure Lactate
-Greater than 4 is critical
Obtain Blood Cultures
-X2 sites, 2 bottles per site (anaerobic and aerobic)
Initial fluid resuscitation: 30ml/kg (run it wide open)
Begin broad spectrum antibiotics
-Zosyn and Levaquin are common
Closely monitor hemodynamics
-B/P Q10-15min,
Repeat Lactate at 2 hour mark
-Lactate should go down
Sepsis Monitoring Labs
Redraw Lactate q4 hours
Sepsis Monitoring Meds
Vasopressors for hypotension persisting after fluids
-Titrate to maintain MAP above 65
Sepsis Monitoring
Place CVC & A-line with monitoring
-Keep CVP between 8 and 12 (12 to 15 if vented)
-Keep SCVO2 above 70%
-A-line continuous B/P monitoring & ABG’s
Sepsis Urine Monitoring
Keep urine output greater than 0.5ml/kg/hr
Sepsis Vented Monitoring
-ensure Vt at 6ml/kg of IBW
-monitor FiO2/PaO2 ratio
-assess for ARDS
-assess for abdominal compartment syndrome (3rd spacing)
How often to assess for sepsis
-At least once per shift
-Ideally twice per shift
Who to test for sepsis
Everyone
Shock
A clinical syndrome
-Life-threatening response to alterations in circulation
-Inadequate tissue perfusion
-Imbalance between cellular oxygen supply and demand
-Impacts all body systems
Shock patho
Shock begins with cardiovascular system failure
Shock Alterations
Alterations in at least one of four components:
Blood volume
Myocardial contractility
Blood flow
Vascular resistance