SIRS/Sepsis/MODS

Question 1

Define SIRS:

Answer 1

Widespread systemic infection that can be infectious/non-infectious

Question 2

T/F: SIRS is always 2ry to underlying disease process

Answer 2

True

Question 3

Hallmarks of SIRS [3 things]

Answer 3

1. Perfusion abnormalities
2. Microcirculation
3. Organ damage

Question 4

T/F: Untreated MODS/DIC can lead to SIRS

Answer 4

False, untreated SIRS can lead to MODS/DIC

Question 5

What is the # of criteria we look for in defining SIRS in dogs vs cats?

Answer 5

Dogs = 2+ things

Cats = 3+ things

Question 6

What are some SIRS criteria for dogs? [4]

Answer 6

Temp: under 100.6 or over 102.6

HR: over 120

RR: over 20

WBC: left shift, under 6k, over 16k

Question 7

What are some SIRS criteria for cats? [4]

Answer 7

Temp: under 100, over 104

HR: under 140, over 225

RR: over 40

WBC: under 5k, over 19k

Question 8

What are some infectious diseases that can be seen with SIRS?

Answer 8

Septic peritonitis
Pyothorax
Endocarditis
Bacterial fasciitis 
Parvo

Question 9

What are some non-infectious diseases that can be associated with SIRS?

Answer 9

Pancreatitis
Immune-mediated dz
Heat stroke
Trauma

Question 10

T/F: non-infectious SIRS can become infectious SIRS

Answer 10

True

Question 11

Define sepsis:

Answer 11

Sepsis = SIRS+life-threatening dz+organ dysfunction

Question 12

What is septic shock?

Answer 12

It is sepsis-induced hypotension that persists even when we administer fluids!

Question 13

Sepsis vs septic shock? Which has a greater risk of mortality?

Answer 13

Septic shock

Question 14

T/F: SIRS patients always have sepsis but septic patient’s don’t always have SIRS

Answer 14

False!!!!

Septic patients ALWAYS have SIRS but not vice versa!

Think back to the sepsis definition!

Question 15

How do septic dogs vs cats present?

Answer 15

Dogs are more “hyper”: hyperdynamic, hypermetabolic, tachycardia, tachypnea, pyrexia

Cats are more “hypo”: lethargic, bradycardia, hypothermia, pale

Question 16

Major treatment approach for sepsis:

Answer 16

Hemodynamic optimization and goal-directed therapy

Question 17

What is hemodynamic optimization and goal-directed therapy?? What are the 3 parts to it?

Answer 17

The main tx option for sepsis!

3 parts: volume optimization, oxygen optimization, vascular tone

Question 18

What is volume optimization treatment?

How do we administer it?

Answer 18

Giving fluids to make sure BP is up, normalize lactate, improve mentation/HR, etc.

Administer 1/3 shock dose and reassess before giving more

Question 19

What is cat vs dog shock dose?

Answer 19

Dogs = 80ml/kg

Cats = 50ml/kg

Question 20

What is oxygen optimization treatment?

Answer 20

O2 and possible blood transfusions

Question 21

What is vascular tone treatment?

Answer 21

Vasopressors!

Norepi, dopamine, vasopressin, dobutamine

Question 22

You have a septic P that you have just treated. Now you are seeing new signs once they have been resuscitated. What does this tell you?

Answer 22

MODS!

Question 23

T/F: When we have a septic P we need to administer abx asap!

Answer 23

True - we need to administer emperic abx while we wait for cultures

Question 24

Name a few emperic abx options:

Answer 24

Ampicillin
Enrofloxacin
3rd gen. Cephalosporins
Clindamycin

Question 25

What is MODS?

Answer 25

Altered organ function where hemostasis can’t be maintained without intervention

Question 26

Give an example of the MODS 1-hit model:

Answer 26

Dogs gets HBC

Question 27

Give an example of the MODS 2-hit model:

Answer 27

Trauma + aspiration pneumonia

Question 28

Give an example of the MODS sustained-hit model:

Answer 28

Continuous insult like drug-resistant bacterial infection

Question 29

How can we try to treat MODS?

Answer 29

Limit shock
Hemostatic resuscitation
O2 support
Early enteral nutrition