Sepsis & Shock Flashcards
presence of systemic inflammatory response syndrome (SIRS) in addition to a documented or presumed infection
Sepsis-2
presence of 2 or more of the following:
- fever >38 or <36
- HR > 90
- RR >20 or PaCO2 <32 mmHg
- abnormal WBC count >12000 or <4000 or >10% immature band forms
SIRS
life-threatening organ dysfunction due to a dysregulated host response to infection
Sepsis-3
Three criteria to calculate qSOFA score
- hypotension (SBP <100)
- Altered mentation (Glasgow coma scale <15)
- Tachypnea (>22)
subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality
Septic Shock
What are the clinical criteria for septic shock?
- Sepsis
- Hypotension requiring vasopressors to maintain mean arterial pressure >65 mm Hg despite fluid resuscitation
- Lactate > 2 mmol/L
List SOFA variables
- PaO2/FiO2 ratio
- Glasgow coma scale score
- Mean arterial pressure
- administration of vasopressors with type and dose rate of infusion
- serum creatinine or urine output
- bilirubin
- platelet count
What are the most common co-morbidities in sepsis patients?
Diabetes and cancers
What is the most appropriate plan of action for a client with septic shock?
Provide early cardiovascular support for IV fluids and vasoactive agents to maintain CVP, MAP, and ultimately tissue perfusion.
Reduced stroke volume (or heart rate) causes what type of shock?
Cardiogenic
Impaired flow causes what type of shock?
Obstructive
Reduced preload causes what type of shock?
Hypovolemic
Reduced systemic vascular resistance causes what type of shock?
Distributive
Heart attack, viral heart infection, conduction abnormality, severe heart valve problems
Cardiogenic
Massive pulmonary embolism, significant pericardial effusion, tension pneumothorax, cardiac tumour
Obstructive
Bleeding (trauma, ulcer), dehydration (heat, shock, diuretics, diarrhea)
Hypovolemic
Sepsis, anaphylaxis, adrenal insufficiency, acute hepatitis, over active thyroid, acute spinal cord injury
Distributive
What contributes to the pathogenesis of organ dysfunction, sepsis, and shock?
hypoxia, mitochondrial/cellular/immune dysfunction, loss of systemic homeostasis, and barrier failure.
part of the innate immune system that reacts rapidly when the tissue injury is detected
the inflammatory response
what is the largest group hospitalized for sepsis?
those over 65 years
what gender is sepsis more common in?
males
___ is a hallmark of sepsis, causing depletion of ATP
mitochondrial dysfunction
___ sepsis accounts for much of the sepsis hospitalization in the very young.
neonatal
pyruvate must be converted to ___ to allow energy production to continue
lactate
ongoing anaerobic metabolism results in a _____
drop in pH due to lactic acid buildup
one type of shock that involves bradycardia + warm/dry skin
neurogenic shock
what do the acinar cells generate?
proteolytic enzymes, amylase and lipases in nonactive forms
what activates the proteolytic enzymes
trypsin
what is the most common symptom in pancreatitis?
severe epigastric or mid-abdominal pain
what is the preferred drug for pain relief in pancreatitis?
meperidine hydrocholride or Demerol
what is the most specific and sensitive diagnostic marker for pancreatitis?
elevated serum lipase level
what is used to evaluate disease severity in pancreatitis?
C-reactive protein (CRP)
2 most common causes of pancreatitis
gallstones or alcoholism
