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