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Pharmacy Year 2 Semester 2 > Septic shock > Flashcards

Septic shock Flashcards

1
Q

Define sepsis

A

The presence (probably or documented) of infection together with systemic manifestations of infection”

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2
Q

What is meant by “systemetic manifestations of infection”?

A
  • pyrexia
  • pallor
  • tachycardia
  • raised infection markers in blood (CRP, WCC)
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3
Q

define severe sepsis

A

“Sepsis PLUS sepsis-induced organ dysfunction or tissue hypoperfusion”

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4
Q

Give 5 signs of severe sepsis

A
  • Low urine output (<0.5ml/kg/hour)
  • low arterial oxygen concentrations
  • changes in blood clotting (INR>1.5)
  • Raised bilirubin (>70micromol/L)
  • raised lactate (>1mmol/L)
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5
Q

define septic shock

A

aka SIRS
“Sepsis-induced hypotension persisting despite fluid resuscitation”

SBP <90mmHg
OR
Mean arterial blood pressure below 70mmHg

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6
Q

Where are the infections that cause sepsis?

A

Infections anywhere in the body can cause sepsis

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7
Q

What are the risk factors for sepsis?

A
  • Immunocompromised (HIV infection or cancer chemotherapy)
  • Neonates and infants
  • chronic disease
  • recent surgery
  • invasive procedures (central lines, urinary catheters)
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8
Q

Describer the pathophysiology of sepsis

A
  • septic shock is a deregulated inflammatory response
  • bacterial proteins activate cellular defence mechanisms
  • release of inflammatory cytokines (TNF, IL-1, IL-6)
  • nitric oxide release, which triggers vasodilation
  • activation of complement which causes cell requirement of lymphocytes, leucocytes and macrophages
  • endothelial action which is nitric oxide mediated, allows immune cells to stick and stay where needed, causes capillaries to become more porous
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9
Q

What does vasodilation cause in sepsis?

A
  • a reduction in systemic vascular resistance
  • hypotension
  • reduction in consciousness
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10
Q

What happens when the body becomes fluid deplete as a result of vasodilation?

A
  • hypovalaemia
  • tissue oedema
  • perfusion of tissues is reduced
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11
Q

Reduced perfusion of tissues causes what?

A
  • tissue ischaemia

- increasing lactate

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12
Q

What are the sepsis 6? When do you have to them?

A

Do within 1 hour:

  • administer oxygen
  • take blood cultures
  • give broad spectrum antibiotics
  • give fluid resuscitation
  • Measure lactate and haemoglobin
  • measure urine output

Mnemonic: OBAFLU

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13
Q

With regards to oxygen administration, what are the goals?

A
  • Increase blood oxygenation

- increase oxygen delivery to organs

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14
Q

When giving oxygen, what is the treatment?

What are the indicators?

A

100% Oxygen through face-mask (=24L/min flow)

Indicators are lactate and venous oxygen saturation

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15
Q

What is the guidance regarding blood cultures?

A
  • Start smart, then focus
  • Do not delay antibiotics waiting for blood cultures
  • empirical therapy based on likely organism
  • Note: most patients with sepsis will be culture negative after a single dose of antibiotic
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16
Q

What are the goals and treatment of broad spectrum antibiotics?
What are the indicators?

A

-Treatment depends on what you’re treating
-empirical therapy for first 48 hours
Indicators are:
-Inflammatory makers (CRP, temperature, WCC, Procalcitonin)

17
Q

What does “start smart, hit hard and fast” mean?

A

Maximum dose

Maximum frequency

18
Q

Describe empirical antibiotic therapy

A

Gram negative and positive cover at first:

-3rd generation cephalosporin (e.g. ceftriaxone)

19
Q

What do you add in to antibiotic therapy in the case of neutropenia?

A
  • Use broad spectrum penicillin to give greater Pseudomonas cover (piperacillin)
  • add in aminoglycoside, but make sure it is a single dose as needs to be renal sparing
20
Q

What do you add in to antibiotic therapy in the case of an acute abdomen infection?

A

-add in metronidazole to fight anaerobes

21
Q

what do you do when cultures are returned?

A

Choose more appropriate, narrow spectrum antibiotics

22
Q

Antibiotics for Staphylococci infections

A
  • Flucloxacillin
  • Rifampicin (if a bone or joint infection)
  • Vancomycin (if MRSA)
23
Q

Name 2 coliforms

1) Penicillin sensitive
2) penicillin resistant

A

1) Co-amoxiclav

2) Carbapenem

24
Q

Pseudomonas infection, what do you give?

A

Ceftazidime (if penicillin sensitive)

25
Q

Goals of fluid resuscitation

A
  • restoration of circulating blood volume

- improving tissue perfusion

26
Q

indicators for fluid resuscitation

A
  • lactate
  • venous oxygen saturation
  • urine output
  • blood pressure
27
Q

Treatment for fluid resuscitation

A
  • 0.9% sodium chloride infusion given AS FAST as POSSIBLE

- blood and plasma

28
Q

1) What is lactate a marker of?

A
  • anaerobic respiration
  • byproduct of glucose metabolism
  • alerts tissue hypoxia
29
Q

Normal reference range of lactate?

A

0.5-2mmol/L

30
Q

Why is urine output monitored?

A

-marker of kidney function

31
Q

why is creatinine not monitored as much as urine output?

A

Creatinine is a poor marker of acute kidney injury

32
Q

What is a good urine output? What is it a sign of?

A

> 0.5mL/kg/hour

  • adequate kidney perfusion
  • clearing the fluid administered
  • sign of adequate organ perfusion
33
Q

Golden Hours of sepsis

-Completed within 3 hours

A

3 hours:

  • measure lactate level
  • obtain blood cultures prior to antibiotic administration
  • administer broad spectrum antibiotics
  • administer 30mL/kg crystalloid for hypotension or lactate >4mmol/L(or equal to)
34
Q

Golden hours of sepsis

-complete within 6 hours

A
  • apply vasopressors for hypotension that does not respond to initial fluid resuscitation to maintain MAP of >65mmHg
  • in event of persistent arterial hypotension despite resus or initial lactate above or equal to 4, measure CVP and ScVO2
  • remeasure lactate if initial lactate was elevated
35
Q

What is CVP?

A

Central venous pressure

36
Q

What is ScVO2?

A

Central venous oxygen saturation

37
Q

What are the 2 most impactful interventions in sepsis management?

A
  • Blood cultures
  • antibiotics

Twice as many survivors in the intervention group than those who didn’t receive the intervention

Pharmacy Year 2 Semester 2 (33 decks)

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