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**Host and Defense > Septic shock > Flashcards

Septic shock Flashcards

1
Q

What does SIRS Stand for?

A

Systemic Inflammatory Response Syndrome

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2
Q

What are the 4 criteria for SIRS?

A
  1. Temperature
  2. Heart Rate
  3. Respiratory Rate
  4. WBC
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3
Q

What temperatures would indicate SIRS/

A

> 38C (100.4F)

<36 C (96.8)

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4
Q

What heart rate would lead you to suspect SIRS?

A

> 90bpm

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5
Q

What respiratory rate would indicate SIRS?

A

> 20rpm (pCO2 < 32)

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6
Q

What WBC would indicate SIRS?

A

> 12,000K/ul or <4000

Or >10% bands (immature forms)

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7
Q

In order to have SIRS, how many of the criteria do you have to have?

A

At least 2

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8
Q

According to ACCP/SCCM what is an infection?

A

-Inflammatory response to microorganisms

or

-Invasion of normally sterile tissues

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9
Q

What is the ACCP/SCCM definition of SIRS?

A

Systemic response to a variety of processes

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10
Q

What is the ACCP/SCCM definition of sepsis?

A

-Infection plus two or more SIRS criteria

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11
Q

What is the ACCP/SCCM definition of Severe Sepsis?

A
  • Sepsis

- Organ Dysfunction

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12
Q

What is the ACCP/SCCM definition of Septic Shock?

A
  • Sepsis

- Hypotension despite fluid resuscitation

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13
Q

What is the ACCP/SCCM definition of Multiple Organ Dysfunction Syndrome?

A
  • Altered organ function in an acutely ill patient

- Homeostasis cannot be maintained without intervention

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14
Q

What does MODS stand for?

A

Multiple Organ Dysfunction Syndrome

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15
Q

T/F Anyone can present with sepsis and severe sepsis

A

True

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16
Q

Who are those who most often present with sepsis?

A

Those with pre-existing diseases such as:

  • Cirrhosis
  • Malignancy
  • AIDS
  • COPD
  • Diabetes
  • Cancer Therapy
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17
Q

What is the worldwide breakdown of organisms that cause sepsis today?

A

62% gram negative
47% gram positive
19% fungal

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18
Q

Hypotension in septic shock is defined as ________

A

<90 mmHg systolic

  • or MAP of 70mmHG
  • or reduction of SBP of 40mmHg from baseline
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19
Q

What are the differential diagnosis for shock/hypotension?

A
  1. Endocrine
  2. Neurogenic, anaphylactic
  3. Drugs, Distributive
  4. Septic
  5. Hypovolemia
  6. Overdose, Obstruction
  7. Cardiogenic
  8. Kills–all of these things will kill you if you don’t figure out what is going on to treat them
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20
Q

What is sepsis?

A

The clinical syndrome that results from a dysregulated inflammatory response to infection

21
Q

Hypotension is often associated with ______

A

Organ damage or dysfunction

22
Q

Secondary Multiple organ dysfunction is due to what?

A
  • NOT due to infection itself
  • Due to the host’s response

*Possibly dysregulation of the innate immune system

23
Q

Primary multiple organ dysfunction is due to what?

A
  • Result of well-defined insult.

- Renal failure from muscle to breakdown products

24
Q

What is Rhabdomyolysis?

A

the destruction of striated muscle cells

25
Q

What are the 3 mechanisms of tissue injury?

A
  1. Ischemia
  2. Cytopathic injury
  3. Increased apoptosis
26
Q

What is ischemia?

A

Decreased O2 givien tissue needs

*often an uptake and not just delivery problem

27
Q

What is Cytopathic injury?

A

Inflammatory mediators cause damage (direct and indirect)

28
Q

What is apoptosis?

A

Programmed cell death

29
Q

What does PIRO stand for?

A

Predisposition
Insult
Response
Organ Dysfunction

30
Q

What is involved in the treatment of Sepsis?

A
  1. Gather data
  2. ABCs as normal
  3. Monitor Tissue perfusion
  4. Goal to restore tissue perefusion- Fluids > vasopressors
  5. Source control
  6. Monitor response to therapy
  7. Begin ICU prophylaxis, nutrition, PT etc.
31
Q

What is some data your would gather to treat sepsis?

A
  1. Cultures
  2. CBC
  3. Chemistries
  4. Coags
  5. U/A
  6. EKG
  7. CXR
  8. ABG
32
Q

What are some methods of source control in sepsis?

A
  1. Antibiotics
  2. Debridement
  3. Surgery
33
Q

What is the 6 hour Resucitation bundle?

A
  1. Early Identification
  2. Early Antibiotics and Cultures
  3. Early Goal Directed Therapy
34
Q

What signs in the CNS might indicate acute organ dysfunction as a marker of severe sepsis?

A
  1. Altered Consciousness
  2. Confusion
  3. Psychosis
  4. Delirium
35
Q

What signs in the respiratory system might indicate acute organ dysfunction as a marker of severe sepsis?

A
  1. Tachypnea
  2. Hypoxemia
  3. Oxygen saturation <90%
  4. Decreased ratio of arterial oxygen vs. inspired oxygen
36
Q

What signs in the liver might indicate acute organ dysfunction as a marker of severe sepsis?

A
  1. Jaundice
  2. Increased liver enzymes
  3. Hypoalbuninemia
  4. Increased prothrombin time
37
Q

What signs in the Cardiovascular system might indicate acute organ dysfunction as a marker of severe sepsis?

A
  1. Tachycardia
  2. Hypotension
  3. Increased central venous pressure
  4. Increased pulmonary artery occlusive pressure
38
Q

What signs in the Kidney might indicate acute organ dysfunction as a marker of severe sepsis?

A
  1. Oliguria
  2. Anuria
  3. Increased creatine
39
Q

What hematological signs might indicate acute organ dysfunction as a marker of severe sepsis?

A
  1. Thrombocytopenia
  2. Abnormal Coagulation tests
  3. Decreased levels of Protein C
  4. Increased D-Dimers
40
Q

In PIRO, what are things involved in predisposition?

A
  1. Host factors
  2. Co-morbidities
  3. Genetics
41
Q

In PIRO, what are things involved in Insult?

A
  1. Specific infecting organism with special weapons (PAMPS)

Examples:

- Ebola
- Gram negative with LPS
- MRSA with cytolytic toxins
42
Q

In PIRO, what is involved with Response?

A

Activation of the immune system (DAMPs)

43
Q

In PIRO what is the organ dysfunction?

A

collateral damage

44
Q

In monitoring tissue perfusion, what does the clinical assessment involve?

A
  • Skin
  • Urine output
  • MSE
  • etc.
45
Q

In monitoring tissue perfusion, the pH and lactate have 2 mechanisms. What are they?

A
  1. Hypoxic

2. Non hypoxic

46
Q

Describe the hypoxic mechanism

A

Anerobic production of lactate

*global with shock or local with bowel infarction

47
Q

Describe the non hypoxic mechanism

A

Decreased clearance of lactate or accelerated aerobic glycolysis

48
Q

What is the historic survival of sepsis if lactate is greater than 10?

A

less than 10%

**Host and Defense (31 decks)

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