Septic Shock Flashcards
What is sepsis-3
Life threatening ORGAN DYSFUNCTION OR DAMAGE (SOFA greater than 2) due to disregulated host response to INFECTION
What is shock
A state in which there is failure of the circulatory system to maintain adequate cellular perfusion and/or oxygen delivery
What are the three vital components of shock
Arterial hypotension (absolute or relative/ MAP less than 65), clinical signs of hypoperfusion, abnormal cellular oxygen metabolism (hyperlactatemia)
What is the major criteria of the Systemic Inflammatory Response Syndrome (Hint: two or more of the following
Temperature greater than 100.4F (38.3C) OR less than 98.6F (36C)
Heart Rate greater than 90 beats per min
Respiratory rate greater than 20 breaths per min or PaCO2 less than 32 mmHg
WBC greater than 12,000 OR less than 4000 OR greater than 10% are bands
What is the most likely cause of SIRS
Infection
What is Septic shock
Sepsis that currently causes ORGAN DAMAGE PLUS VASOPRESSORS given to maintain MAP greater than 65mmHg PLUS serum lactate greater than 2 mmol/L
What are vasopressors
Medications that contract blood vessels and raise blood pressure used to treat severely low blood pressure for those who are critically ill
What are the two biggest culprits for organisms that lead to sepsis, what comes in as a faraway 3rd
Gram positive and gram negative organisms, fungi
T/F: Patients will have an extremely high chance of dying from septic shock if there are more than two organ systems that are in dysfunction
True
What is the KEY difference between septic shock and other shocks
Septic shock DOESN’T have an initial decrease in Cardiac Output (high output shock state)
What is the disease continumm of septic shock and the mortality associated
Infection (no SiRS): 20%/ SiRS plus suspected infection: 20%/ Sepsis with organ damage: 30%/ Septic shock: 50%
In Sepsis what causes the immune system to defend and what is the consequence with regards to blood
Infection releases endotoxins that causes the immune and inflammatory response, the inflammatory response then causes the procoagulation pathway to be activated increasing the amount of microvascular thrombi
How does the increase in thrombin lead to more targeted organ damage (Hint: method, and direct 3 consqeuences)
Fibronolytic response tries to reduce the procoagulation but the anti-fibronolytic stumps this response leading to more clotting causing less blood to the organs/ enhanced formation of clots, thrombosis of small vessels, impaired tissue perfusion
What are the two proteins that causes thrombi to not be broken down in the anti-fibronolytic stage of sepsis
Thrombin-activatable fibrinolysis inhibitor (TAFI) and Plasminogen activator inhibitor 1 (PAI-1)
What is the biggest hemodynamic change in Septic shock why
Systemic vascular resistance reduced due to the inflammatory response in the body
What are the other hemodynamic compensations for Septic shock
Increased Heart rate, Cardiac output early is increasing but late it decreases, decreased preload
What is the most important fact about antimictrobial therapy for sepsis
Administration of effective antibiotics within the first hour of recognition
What are the early goal directed therapy for paitents with Septic Shock
Volume resuscitate the patient (check if CVP 8-12 mmHg), check the arterial pressure (MAP greater than 65), check for organ malperfusion
Which crystalloids would go into the intravascular space as needed
Normal Saline, Lactated Ringers, and Plasmalyte/ 30mL/kg IV bolus using total body weight
T/F: Colloids, such as albumin, are first line for giving volume to patients with Septic shock
False: Crystalloids are first line
When would patients recieve colloids instead of crystalloids
Patient starts to have pulmonary edema, renal failure, liver failure, unable to remove the excess fluid
What is the order for vasopressors used in Septic shock, which have little to not great data, what should never be used and why
Norepinephrine, vasopressin, epinephrine/ Angiotensin 2 and phenlyepherine/ dopamine
What receptors are needed to be activated when using vasopressors
Alpha 1 agonist
When would an ionotrope be given in Septic shock, what is the risk
If the patient still has organ failure after adequate volume resuscitation, Dobutamine, arrhythmias
In shock what should be elevated due to it being a stessful enviornment
Cortisol
When can it be determined that a patient has adrenal insufficiency in Septic Shock, what is this called
Patient hypotension resonds poorly to adequate fluid resuscitation and vasopressors (often 2 vasopressors) Catecholamine refreactory septic shock
Which corticosteroids would be given for catecholamine refreractory septic shock, benefits
Hydrocortisone 200-300 mg/day, gets patient off vasopressors quicker and improves mortality
What are the parameters of the quick Sofa score
SBP less than 100 mmHG (low blood pressure), Respiratory rate greater than 22 breaths per minute (fast respiratory rate), Glascow coma score less than 15 (altered mental status)
What are other things patients need for if sent to the ICU
VTE prophylaxis, insulin, stress ulcer prophylaxis
