Septic shock

Question 1

Patient after anterior resection POD4 .. RR is 28 per min BP : 80\50, PULSE 110 temp 38.5 and UOP -450 ml in 24 hours .

Q1. what is your diagnosis?

Answer 1

Septic shock

Question 2

Q2: What is the DD ?

Answer 2

DDx; Anastomotic leakage , Peritonitis, UTI , wound sepsis, hospital acquired chest inf.

Question 3

Q3. What is quick SOFA score?

Answer 3

2 of 3
Scoring system using to dx sepsis that include 3 parameters SBp/GCS/RR

Question 4

Q4.What are causes of AKI ?

Answer 4

Pre-renal; Hypovolumeia, Dehydration, HF
Renal; ATN, GlumNephritis
Post; Obstructive Stones / malignancy

Question 5

Q5.What are the investigations you would order ?

Answer 5

FBC/ABG / CRP / U&E/
Blood Cultre + Levels of Lactate
Img; US / CT scan

Question 6

Q7. How will you check response to ttt?

Answer 6

Vital signs / UOP / CRT / Mental status

Question 6

Q6. Management of sepsis ?

Answer 6

CCRISP + Spesis 6
Renal support (frusemide) + Nutritional Supp.
findout source of it and ttt

Question 7

Q.8 Given the following ABG what’s Dx?

Answer 7

Met. Acidosis
Due production of lactic acid from anaerobic glycolysis
from the hypoxia

Question 8

Q9. Def. of Shock?

Answer 8

Life threatening condition of circulatory failure due to Tissue hypoxia due to lack of oxygenation (↓delivery, ↑ consumption , inadq utilization)
Sept Shock; sepsis + pt is not responding to vasopressors and LDH > 2
Sepsis  Susp. Inf. + 2 or more of qSofa
—–
Sepsis Servival Guidelines
3hrs bundle measure lactate / Blood cultre / Give Abx / Give 30 ml/kg of crystaloids
6h bundle hypotension not responding to fluids and in case of peripheral art hypotension despite volum resus you should measure CVP / O2 sat and measure lactate if initially was elevated

Question 9

Q10. How to DD btw Septic and Hgic Shock?

Answer 9

S; Warm prephiray
Hgic; Cold prephiray