Sepsis/ Shock Flashcards
What SOFA score defines sepsis?
> /= 2 point increase from baseline; if baseline unknown assume 0
What is the definition of septic shock?
- Spesis
AND - Vasopressor therapy needed to elevate MAP >65
AND - lactate >2 mmol/L despite adewuate fluid resuscitation
What are the most common causes of septic shock?
- pneumonia
- GI infection
- UTI/ pyelonephritis
What is the pathology of septic shock?
Pro-inflammatory mediators overrespond to infection leading to:
1. vasodilation and decreased BP
2. loss of barrier function (third spacing) and hypoperfusion
3. decreased tissue oxygenation
4. organ failure
What is Type A hyperlactatemia?
overproduction in ischemic tissue due to anaerobic metabolism (hypovolemic, septic, cardiogenic shock)
What is type B hyperlactatemia?
not related to tissue hypoxia, decreased clearance of lactate (drugs, liver/renal failure, cancer)
What 6 systems is the SOFA score assessment on?
- Neurologic- Glasgow coma scale
- Respiratory- PaO2/FiO2 ratio
- Circulatory- MAP
- Renal- SCr
- Hematologic-Platelets
- Liver- T.bili
What is first line for increasing BP in septic shock?
fluid challenge of 30mL/kg within first 3h
What is 1st line if fluid challenge failed?
Norepinephrine 0.5-3 mcg/kg/min IV until MAP >65
What is 2nd line if fluid challenge failed?
Norepinephrine
AND
Epinephrine
+/- Vasopressin 0.04 units/min
What SEs do Angiotensin II (GIAPREZA) have?
- DVTs
- thrombocytopenia
- peripheral ischemia
- hyperglycemia
- acidosis
What IV corticosteroid is given with vasopressor therapy?
Hydrocortisone 200mg/day (50mg IV Q6h)
What antibiotics are given for septic shock?
broad-spectrum antibiotics to cover MRSA and pseudomonas if no source is found
When should antimicrobials be started for possible septic shock with high likelihood of sepsis?
within 1 hour of recognition
When should antibiotics be started for possible sepsis without shock?
within 3 hours of recognition
