Septic Shock Flashcards
Septic shock occurs when
circulatory and metabolic abnormalities are profound, greatly increasing mortality.
Multiple Organ Dysfunction Syndrome (MODS)
Altered function of > 1 organ system requiring interventions to achieve homeostasis.
Septic Shock causes
vasodilation which leads to pooling of blood in venous system; relative hypovolemia; decrease venous return.
Etiology of Septic Shock
Pneumonia
Urinary tract infections
Endocarditis
Abdominal infections
CAUTI
CLABSI
Septic Shock Risk Factors
Very old & very young
Chronic illnesses
Malnutrition
Broad spectrum antibiotic overuse
Surgical or invasive procedures
Immunosuppressed patients
Invasive Equipment: IVs & tubes: Foley, peg tube.
SIRS
Systemic Inflammatory Response Syndrome
Systemic Inflammatory Response Syndrome (SIRS) Parameters
2 or more of the following
Core temperature below 96.8 °F (36° C) or above 100.4° F (38° C)
Heart Rate > 90 beats/minute
Respiratory rate > 20 breaths/minute
WBC count > 12,000 cells/microliter
Altered mental status.
Blood glucose > 140 mg/dL in the absence of diabetes (stress hyperglycemia)
SOFA
Sequential Organ Failure Assessment
Signs of Organ Dysfunction or Hypoperfusion
Systolic BP <90 or MAP <65 MAP (70-105)
Or a decrease in pts. baseline systolic BP of >40 mmHg (ex:140/80 to 95/65)
**Lactate > 2-4 mmol/L (norm .5-1.0) WHY??
Increasing O2 need/ mechanical ventilator support.
Creatinine > 2.0 mg/dl
Urine output < 0.5 mL/kg/hr. (for at least 2 hours)
Bilirubin > 2 mg/dL
Platelet count < 100,000 µL
Coagulopathy (INR > 1.5 or aPTT > 60 secs)
Normal bilirubin
1.2 mg/dl under age 18, 1mg/dl
Normal PT
10-13.5 seconds
Normal INR
.8 to 1.2
Normal PTT
30-45 sec
Normal Lactate level
4.5mg/dl- 19.8mg/dl
Calculate MAP
SBP + 2 (DBP) / 3
Oliguria
urine of 400ml/24 hours
16ml/hr
Anuria
Urine output of 100 ml/24 hr
4ml/hr
Septic Shock Symptoms – Early Stage
**known as warm shock: Due to Initial Inflammatory Response. Hyperdynamic state
SVR is low due to vasodilation.
**Warm, flushed skin extremities.
Fever, Hyperthermia
Tachycardia
Tachypnea
BP initially normal to low
CO initially increased R/T hyperdynamic state
**Decreased urine output.
Change in mental status (LOC) from time of admission.
May be subtle… listen to family!
State of relative hypovolemia
Warm shock
A hyperdynamic state. Warm extremities associated with Septic Shock. But BP and HR similar to most other types of shock.
Late Signs & Symptoms
**Late (cold shock) Unable to Compensate
Signs/symptoms related to specific organ failure.
Tachycardia & Hypotension
Decreased CO
Weak and thready pulses
Confusion and decreased LOC
Cool and pale extremities
Hypothermia & Peripheral cyanosis
Petechiae flat tiny red spots and/or purpura (rash of purple spots) & skin mottling
Complications of Septic Shock
Disseminated Intravascular Coagulopathy (DIC)
Multi Organ Dysfunction System (MODS)
Disseminated Intravascular Coagulopathy (DIC)
1st stage of DIC lasts hours to days.
A hematological disorder most often caused by sepsis.
Abnormal clots form inside blood vessels that effect the body’s clotting factors & cause massive bleeding in other areas.
Acute DIC: Clotting stage followed by bleeding stage.
Chronic DIC: Clotting
Disseminated Intravascular Coagulopathy (DIC) Treatment
.9NS IVFs; Blood; FFP (plasma) & platelets (if acute)
Multi Organ Dysfunction System (MODS)
Excessive inflammation related to severe injury or sepsis
First organ affected= Lungs. Acute Resp. Distress Syndrome (ARDS)
Other organs affected= Kidney, Liver and GI systems affected
Mortality rate for MODS= 40%
If neuro & cardiovascular systems affected, mortality rate increase to 100%
