Septicemia Flashcards

1
Q

Septicemia

A

presence of pathogens and toxins in blood

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2
Q

Bacteremia

A

presence of bacteria and toxins in the blood

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3
Q

sepsis

A

whole body inflammation caused by infection

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4
Q

SIRS Criteria

A

(any two)

  • temp greater than100.4 or less than 95.0
  • RR greater than 22 or PaCO2 less than 32
  • HR greater than 90
  • WBC greater than 12,000 or less than 4,000
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5
Q

SIRS

A

Systemic Inflammatory Response Syndrome

  • a systemic inflammatory response
  • typically an immune response to infection but not always
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6
Q

MEWS and PEWS

A
  • modified early warning system
  • pediatric early warning signs
  • like SIRS criteria but may include more/fewer signs
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7
Q

Sepsis is the result of…

A

an infection

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8
Q

With sepsis, the infection is…

A

uncontrolled or spreads and releases bacteria or toxins into the blood

  • this triggers the systemic inflammatory response
  • sepsis is SIRS caused by an infection
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9
Q

Sepsis is ____ caused by an infection

A

SIRS

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10
Q

Cascade of Sepsis

A
  • when inflammatory response becomes exaggerated, inflammation, and coagulation increase
  • leads to microthrombi and obstruction of capillaries
  • endothelial (vein/arterial wall) damage, vasodilation, and increased capillary permeability
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11
Q

Severe Sepsis

A
  • if sepsis is not controlled it enters what we call severe sepsis
  • this is sepsis with one organ system damaged or experiencing failure
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12
Q

DIC

A

Disseminated Intravascular Coagulation

  • widespread activation of clotting which causes clots in small blood vessels
  • leads to a drop in tissue perfusion which can lead to tissue and organ damage, failure
  • sepsis is one of the leading causes of DIC
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13
Q

Even though DIC is characterized by excessive clotting in the intravascular space, the patient is actually at a very high risk for bleeding. Why do you think that is?

A

increased clotting depletes the platelets and clotting factors needed to control bleeding, causing excessive bleeding.

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14
Q

DIC Tx

A
  • monior VS, clotting factors
  • S/S of hemorrhage, bleeding
  • Fix hypovolemia
  • Possibly platelet transfusions
  • possibly heparin, especially prophylactly when DIC is slowly evolving. Not when it is quick
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15
Q

What is shock?

A

-generally it is when there is insufficient blood flow to meets the body’s demands (lack of perfusion)

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16
Q

Septic Shock

A
  • severe sepsis with persistent hypotension which is unresponsive to fluid replacement therapy and organ system damage and/or failure to 2 or more organ systems.
  • MODS (multiple organ dysfunction syndrome)
  • very high mortality rate
17
Q

Organ systems because damaged during septic shock as a result of…

A
  • decreased tissue perfusion
  • hypotension
  • microvascular occlusion (DIC)
18
Q

Compensatory Shock

A
  • Stage 1
  • Baroreceptors detect drop in MAP
  • SNS kicks in, ups HR, and cardiac contraction
  • Peripheral vasoconstriction
  • Perfusion of systems is maintained due to this
  • Signs are nearly imperceptible
19
Q

Progressive Shock

A
  • Stage 2
  • Sustained drop in MAP
  • Compensatory mechanisms from stage 1 are still active, but unable to keep MAP up
  • Vasoconstriction actually starts to limit blood flow
  • lactic acid builds up causing acidosis
  • sodium-potassium pump of cells fails, leads to loss of intracellular K, Na, and water move in
  • cells swell up from Na and water, causes organelle damage
20
Q

Refractory Shock

A
  • Stage 3
  • Tissue damage and lack of O2 become so widespread that tissues and organs fail and die
  • Even if MAP is restored, damage has become too widespread to prevent organ death
21
Q

Early signs of Septicemia

A
  • Hypotension
  • rapid, thready pulse
  • quick, deep respirations
  • warm, flushed skin
  • alert and oriented x3
  • normal urine output
  • elevated temp
22
Q

Late signs of Septicemia

A
  • hypotension
  • Tachycardia, possible arrhythmias
  • rapid, shallow respirations, dyspnea
  • cool, pale, edematous
  • lethargic, possible comatose
  • oliguria or anuria
  • decreased temp
23
Q

Initial tx

A
  • will be early goal directed resuscitation therapy
  • fluid challenge of 30mL/kg of crystalloid solution (NS, D51/2, LR)
  • vasopressors (vasopressin, dopamine, norepi)
  • goal is to raise MAP, HR, urine output more than 0.5mL/kg/hr
24
Q

Albumin

A
  • may see albumin admin along with crystalloid IVFs
  • idea is that albumin acts as an anti-inflammatory and anti-oxidant and helps maintain plasma osmolarity
  • however, benefits compared to only admin crystalloid IVFs are virtually non existent and there is a risk of complications when admin albumin
25
Q

if EGDT is unsuccessful…

A
  • admin to ICU likely
  • antibiotics to tx infection
  • resuscitation via O2, maintaining airway, possible mech ventilation in shock
  • RBC/platelet transfusion
  • external cooling or heating
  • nutritional support, shock pts generally lack sufficient protein
  • vasopressors for hypotension
  • monitor lactate levels
26
Q

Normal Lactate levels

A

0.5-2.0

27
Q

Lactate

A

product of cellular metabolism that can accumulate when cells lack O2