septicemia Flashcards

1
Q

TERMS

A
  1. SEPTICEMIA- presence of pathogens and toxins in blood
  2. BACTEREMIA- presence of bacteria and toxins in the blood
  3. SEPSIS- whole body inflammation caused by infection
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2
Q

SIRS

A
  • systemic inflammatory response syndrome (SIRS)
  • a systemic inflammatory response
  • typically an immune response to infection but not always
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3
Q

SIRS CRITERIA (ANY TWO OR MORE)

A
  1. TEMP ( >100.4 OR <95.0) (>38 OR <36)
  2. RR (>20 OR PaCO2 < 32)
  3. HR (>90/MIN)
  4. WBC ( >12,000 OR <4,000)
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4
Q

SIRS STAGES

A
  1. SEPSIS
    - SIRS with a microbial source
  2. SEVERE SEPSIS
    - sepsis with >one organ system dysfunction (hypotension, AMS, Acidosis, oliguria, ARDS)
  3. SEPTIC SHOCK
    - severe sepsis with hypotension unresponsive to fluid resuscitation
  4. MODS
    - > one organ system requiring interventional homeostasis
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5
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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6
Q

WHAT IS SEPSIS

A
  • sepsis is the result of an infection
  • the infection is 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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7
Q

SEPSIS PROCESS

A

-when the inflammatory response becomes exaggerated, inflammation and coagulation increase

  • leads to microthrombi, and obstruction of capillaries
    (tissue isn’t perfusing )
  • endothelial (vein/arterial) damage, vasodilation, increased capillary permeability
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8
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
  • BP decreases , poor organ perfusion
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9
Q

DISSEMINATED INTRAVASCUALR COAGULATION

A

DIC- 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 or failure
  • sepsis in one of the causes
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10
Q

TREATMENT OF DIC

A
  • monitor vital signs, clotting factors
  • assess for signs of hemorrhage, bleeding
  • fix hypovolemia (give fluid)
  • possibly platelet transfusion
  • possibly heparin, especially prophylactically when DIC is slowly evolving, not when it is quick
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11
Q

WHAT IS SHOCK

A
  • generally , it is when there is sufficient blood flow to meet the body’s demands (lack of perfusion )
  • several types
    1. cardiogenic
    2. hypovolemic
    3. anaphylactic
    4. neurogenic
    5. septic
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12
Q

SEPTIC SHOCK

A

this is 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
  • organ systems become damaged as a result of decreased tissue perfusion
  • hypotension
  • microvascular occlusion (DIC)
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13
Q

STAGE 1: COMPENSATORY SHOCK

A
  • 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
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14
Q

STAGE 2: PROGRESSIVE SHOCK

A
  • sustained drop in BP
  • 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 cels fails, leads to loss of intracellular K, Na and water move in
  • cells swell up from Na and water, causes organelle damage
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15
Q

STAGE 3: REFRACTORY SHOCK

A
  • tissue damage and lack of oxygen become so widespread that tissues and organ s fail and die
  • even if MAP is restored, damage has become too widespread to prevent organ death
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16
Q

SEPTICEMIA EARLY SIGNS

A
  • hypotension
  • rapid, thread pulse
  • quick, deep respirations
  • warm flushed skin
  • alert and oriented x 3
  • normal urine output (>30 ml/hr)
  • elevated temp
17
Q

SEPTICEMIA LATE SIGNS

A
  • hypotension
  • tachycardia, possibly arrhythmias
  • rapid, shallow respirations, dyspnea
  • cool, pale, edematous
  • lethargic, possible comatose
  • oliguria, or anuria
  • decreased temperature
18
Q

ASSESSMENT

A

SEPSIS
-acidotic, cool pale, low BP, low MAP

SEPTIC SHOCK
- low urine output, arrhythmias, LOC decreased, low K, increased NA and water in cells

19
Q

DIAGNOSTIC LABS

A
  • WBC
  • electrolyte
  • PH
  • lactic acid
  • CO2
  • ABG
20
Q

INITIAL TREATMENT

A
  • will be early goal directed resuscitation therapy
  • fluid challenge of 30 ml /kg of crystalloid solution (NS, D5 1/2, lactated ringers ) isotonic
  • vasopressors - vasopressin, dopamine, norepinephrine
  • goal is to raise MAP , heart rate, urine output >0.5 ml/kg/hr
21
Q

ALBUMIN

A

the idea is that albumin acts as an anti-inflammatory and anti-oxidant and helps maintain plasma osmolarity

-however the benefits compared to only administering crystalloid IV fluids are virtually no existent and there is a risk of complications when administering albumin

22
Q

IF EDGT UNSUCCESSFUL

A
  • admittance to ICU likely
  • antibiotics to treat infection
  • resuscitation via oxygen, maintain airway, possible mechanical ventilation in shock
  • RBC/ platelet transfusion
  • external cooling or heating
  • nutritional support, shock pts, generally lack sufficient protein
  • vasopressin for hypertension
  • monitor lactate levels- normal is (0.5-2.0)
    lactate is a product of cellular metabolism that can accumulate when cells lack O2