Sepsis/shock

Question 1

SEPSIS DEFINITION

Answer 1

“Life threatening organ dysfunction secondary to dysregulated host response to infection”

Question 2

Septic shock definition

Answer 2

sepsis : “Life threatening organ dysfunction secondary to dysregulated host response to infection”
+ adequate volume resuscitation
+ Persistent ↓BP requiring vasopressors to keep MAP ≥ 65
+lactate > 2 mmol/L

Question 3

SIRS DEFINITION

Answer 3

2 OR MORE = POSITIVE SCREEN

HR >90
Temp >38 or <36
RR >20 or PaCO2 <32
WBC >12 or <4 or 10% bands

Question 4

SEPSIS IMMEDIATE RESUSCITATION

Answer 4

1.begin rapid administration of at least 30ml/kg (ideal body weight) crystalloid within the first 3h
2 . Use vasopressors if patient is hypotensive during or after fluid resuscitation to keep MAP≥65
3. Give broad spectrum antibiotics within 1 hour
– Obtain blood cultures prior to antibiotics if possible
4. If ICU level care needed, admit to ICU within 6 hours

Question 5

if you have sepsis, and suppose you have either emergency gi surgery or anastomotic leak suspicion, what do you cover for ?

Answer 5

fungal coverage

Question 6

prolonged beta lactam infusion : what was the impact ?

Answer 6

reduced 90 day mortality

Question 7

how do you check for fluid responsiveness

Answer 7

1.SV increase 15% with passive leg raise or fluid bolus
2. pulse pressure variation of 10%
3. sv / svv
IVC ( intubated, fully vent, DI >15-20) vs spont breathing no intubation ( IVC <2 cm, >50% variability in fluid response)

Question 8

Smart trial about IV said what and why ?

Answer 8

Suggest using balanced crystalloid over NS (SMART trial)
– Decreases major adverse kidney events at 30 days (death, new renal replacement, Cr>200% above baseline)

Question 9

permisse hypotension with who ?

Answer 9

> 65 and chronic hypertension

Question 10

what are we worriedd about when it comes to dopamine as vasopressor

Answer 10

Caution re renal/mesenteric vasodilation at low dose, tachy arrhythmia at high dose

Question 11

dobutamine effect and caution

Answer 11

alpha «<beta
hypotension

Question 12

milrinone
effect
increase what
decrease what

Answer 12

• pde5
• co, sv
• svr, pcwp
• cardiac surgery, pulmo htn, some cardiogenic shock

Question 13

vasopessin
- receptor
- effect

Answer 13

• v1 rc on sm msc
• v2 rc on kidney
• used for septic shock
• increase svr and pcw , decrease hr and co

Question 14

isoprotenerol
-receptor
- indication
- increases what
- decxreases what

Answer 14

• alpha «<b1«<b2
• hypotension 2/2 to bradyarrythmia
• ++ hr, co
• decrease svr and pcp

Question 15

why steroids in septic shock
when to consider

Answer 15

may reduce long term and short term mortality

may reduce icu and hosp stay

when norepi 0.25 mcg/kg/min >4hrs

Question 16

intiail carddiogenic shock management

Answer 16

fluid management
consider positive presssure ventilation
norepi for vaso support
ionotrope : dobutaminem/milrinone