Septic Shock Flashcards
Patient comes in with tachycardia tachypnea hypotension no altered mental status have bounding pulses warm extremities with fever and indication on an infection foci
Sepsis by qsofa
Patient need vasopressor to maintain map at 65 and lactate of more than 2 is required though fluid bolus is given what is the patient condition
Septic shock
What is the initial management of septic shock
Iv antibiotics (pip taz ) and fluid resuscitation of 30 ml/kg both should ve started with in 1 hour its best
What vasopressor is drug of choice for septic shock first line
Nor epinephrine
What is the 2nd line drug to reduce nor epi use
Vasopressin 0.09 U
Which drug is contra indicated in tachyarrhythmia patient in septic shock
Dopamine
Drug used when there is no change in hypotension even though of fluid resuscitation and vasopressor
Dobutamine
In which adrenergic receptor dobutamine has more effect
It have more effect on beta AR
No change in hypotension this is the last and final consideration in the patient with septic shock?
Hydrocortisone
When to start insulin in septic shock patient
Cbg BG greater than or equal to 180 mm hg 2 times
What is the target of blood glucose in septic shock patient
Less than or equal to 140
1 hr delay in antibiotics cause how much increase in mortality
3-7% (7.6%)
Most common infection associated with septic shock
Pneumonia
Most common type of bacteria causeing septic shock
Gram positive ( staph areus, strep pneumo) then gram negative (e coli, klebsiella, pseudomonus)
Only shock in which the systemic vascular resistance drops instead of volume in side it
Distributive shock
Only shock in which the cardiac out put is increased
Distributive shock
What is main symptom or sign that patient entered decompensated stage of shock
If patient have all signs of compensation plus altered mental status
Examination finding in low co shocks
Cool extremeties, weak pulses, capillary refill time more than 2 sec
What is the indication for mechvent
Saco2 < 90% + ph <7.20 inadequate compensation
What is the sensitive indicator for transfusion
Shock index = HR / systole bp (normal 0.5 - 0.7)
>0.9 - indication for transfusion
Three windows to check organ dysfunction or organ hypo perfusion
CNS
Skin
Kidney
When can you say there is oliguria or AKI due to sepsis or kidney has hypo perfusion
<0.5 ml/kg/hr in catheter bag
Deug of choice antibiotic for septic shock
Pip taz 4g iv q6hrs
Patient came in dyspneic, diaphoretic, tachypnic, pale cold extremeties, latered mental status or confused bp of < 90 mmhg distended jvp and have oliguria (may be aki) what is the patient condition
Caridogenic shock
Most common cause of cardiogenic shock
MI plus LV dysfunction
Mechanical cause of cardiogenic failure is always present but not in this condition
Takotsubo cardiomyopathy and fulminant myocarditis
Which is most common type of MI causing cardiogenic shock
STEMI
What is a strong independent predictor of mortality in cardiogenic shock during presentation
BLOOD GLUCOSE
Cardiac markers elevated in cardiogenic shock sec to mi
CKMB
TROPININ I AND T
Lab elevated in cardiogenic shock
WBC
CREATININE
C REACTIVE PROTEIN
HEPATIC TRANSAMINASES
LACTATE >2 mmol/L
ABG - hypoxemia and anion gap metabolic acidosis
Glucose
ELEVATED CARDIAC MARKERS
WHICH INFARCT OF THE HEART IS MOST COMMONLY ASSOCIATED WITH CARDIOGENIC SHOCK
Anterior infarct 50%
The main stay treatment and mortality reducer in the cardiogenic shock is
PCI ( percutaneous coronary intervention) > CABG ( coronary artery bypass graft )
What should be addressed first in the cardiogenic shock
MAP and Bp ( 65 and 90 is ok)
Hypoxemia and anion gap metabolic acidosis must be addressed
Highest mortality for this condition if results in cardiogenic shock around 80%
Ventricular septal rupture
IABP -SHOCK SCORE for cardiogenic shock prognisis
Age > 73
Prior stroke
Glucose at admission >191 mg/dL
Creatinine at admission >132.6 umol/L
Atrial blood lactate >5 mmol/L
Mi after pci<3
