Shock, Sepsis, and Hemodynamic Monitoring Flashcards
3 components of qSOFA
- Respiratory rate 22 or more
- Systolic BP < 100
- GCS < 15
Sepsis 3 Diagnostic Criteria of Sepsis
- Presence of probable or documented infection and
- Change in SOFA score of 2 or more
Definition of sepsis induced organ dysfunction
- Lactate elevated
- Urine output < 0.5 ml/kg/hr x 2 hours after adequate fluids
- PF ratio < 250 without pneumonia or < 200 with pneumonia
- Creatinine > 2.0 or a rise 0.5 or more from baseline
- Bilirubin > 2
- Platelets < 100,000
- INR > 1.5
Combination antibiotics for septic shock and respiratory failure
Extended spectrum beta lactam + aminoglycoside
Or
Fluoroquinolone if pseudomonas bacteremia
Combination antibiotic regimen for septic shock from strep pneumo bacteremia
Beta lactam + macrolide
Appropriate time to deescalate antibiotics from dual therapy
3-5 days
Duration of therapy in sepsis is longer than 7-10 days in what 5 reasons
- Slow clinical response
- Undrainable infectious foci
- Staph Aureus bacteremia
- Some fungal infections
- Immunologic deficiencies
Various wave forms of CVP monitoring
A = atrial contraction
C = tricuspid valve closure
V = Atrial filling with closed tricuspid valve
Waveforms in PA catheter
Why no PA catheter if LBBB present?
PAC can induce RBBB which would lead to complete heart block
Clues PAC catheter is in Zone 1 or 2 of lung
- PAD > PCWP
- Lots of respiratory variation
- PAC tip higher than left atrium on supine CXR
Measured vs Derived vs Other variables derived from a PAC
- Measured
- RA pressure
- PA pressure
- Wedge pressure
- HR
- Cardiac Output
- Derived
- Cardiac index
- SVR
- PVR
- Stroke volume
- Other
- BSI
- Systemic arterial pressure
Normal RA pressure
0-8
Normal RV pressure
15-30/2-7
Normal PA pressure
15-30/9-16
Normal Wedge pressure
5-12
Normal cardiac output
4-8
Normal cardiac index
2-4
Diagnosis when RV and PA diastolic pressures are the same
Pericardial tamponade
Requirements for accurate pulse pressure variation
- Sinus rhythm
- Passive respiration
- Adequate tidal volume (8-10/kg)
- Good arterial waveform
Pulse pressure variation that predicts fluid responsiveness
> 12-15%
Passive leg raise equivalent to what volume of bolus
200-300 mL
Technique for passive leg raise
transfer from 45 degrees sitting to supine with legs raised to 45 degrees for 3 minutes
Initial fluid choice in septic shock
- Crystalloids are preferred
- LR associated with decrease in AKI and RRT
- Balanced salt solutions improve survival
Primary receptor of Norepi
alpha and beta-1
Primary receptor of Neo
alpha
Primary receptor in epinephrine
Alpha, beta 1, beta 2
Primary receptor in dobutamine
Beta 1
