SIRS/Sepsis ppt-josh Flashcards
WHO IS THE ONLY WHITE PERSON MIKE LIKES
Hippocrates
(prob b/c he’s dead)
Sepsis is the 2nd leading cause of death in the non-coronary ICU pt’s, dispite inproved care, mortality remains b/t __-__%
30-50%
what is the systemic inflammatory response to a wide variety of severe clinical insults
SIRS
SIRS:
is manifested by TWO or MORE of the following conditions!! what are those 4 conditions???
- Temp >38 C or < 36 C
- HR > 90 bpm
- RR > 20 bpm (or PaCO2 < 32)
- WBC- >12,000 or < 4,000 (or >10% bands)
basically is i walk to the mailbox i get SIRS
WHat is a systemic inflammatory response to an insult to a host, in association w/ infection.
Sepsis:
Sepsis:
what are the clinical manifestations for Sepsis:
same as for SIRS
Sepsis vs SIRS
is they manifest themselves the same how do you differentiate them?
Sepsis:- includes 2 or more of the mentioned conditions but 2ndary to a documented infection
Sepsis:
severe sepsis is associated w/ what 2 things?
Organ dysfunction
or hypotension
Severe Sepsis:
S/s
- Hypoperfusion and perfusion abnormalities may include
- Lactic acidosis
- oliguria
- AMS
Sepsis:
What are examples of potent stimulus for activation of an inflammatory response (4)
- trauma
- Surgery
- Organ dysfuntion
- Infection w/ microorganisms or viruses
Sepsis:
SO what is the patho for this?
Endogenous sensing mechanisms initiate a response NOT specifically for the reconition of infection BUT rather in response to biochemicals that suggest imminent threat to host
Sepsis:
what are some of the biochemical markers
- Cytolines
- TNF-a
- IL-1-6-8
- PAF
- Prostaglandins
- Leukotrienes
- Neutrophil
- Complement system
- Vascular endothelial cells
- Clotting and kinin cascades
- Thromboxane
- prostacyclin
- prostaglandin
Sepsis:
what is the effect that the biomarkers couse in the body
- Vasodilation
- Incrreased Capillary Permeability
- Cellular activation
- Coagulopathy
Sepsis/SIRS: Anesthesia management
what is the central treatment to sucessful treatment of a pt w/ severe sepsis
Srugical removal of impurity
early antimicrobial therapy
Sepsis/SIRS: Anesthesia management
in High-risk surgical or trauma pt’s w/ sepsis, early ________ optimization before the development of organ failure reduced mortality by 23%
hemodynamic
SvO2:
what is it?
saturated venous oxygen
SvO2:
has an _____ relationship to oxygen utilization in fully saturated blood!
Inverse
(lower SvO2: is the more O2 used)
SvO2:
has a _____ relationship to CO and Hemoglobin
Direct
(one goes up the other goes up as well)
SvO2:
w/ constant O2 consumption, mixed venous O2 saturation demonstrates the balance b/t what?
Oxygen delivery and oxygen demand
SvO2:
SvO2 is the result of O2 consumption @ the ____ level!
Tissue
SvO2:
it is the result os O2 consumption at the tissue level. this is measured as the _________
Oxygen Extraction Ration ( O2ER)
SvO2:
What is the Normal O2ER value
24-28%
SvO2:
what is the Calculation for the O2ER?
O2ER = SaO2 - SvO2 / SaO2
- SaO2 - Arterial O2 sat
- SvO2 - mixed venous O2 sat
SvO2:
does a normal SvO2 alone show the status of specific organ perfusion
Nope
SvO2:
is SvO2 alone adequate representation of tissue perfusion in pt’s w/ sepsis?
Again no fucking way
what is the “Golden Hours” of sepsis, and why is this important to us?
- the first 6 hours of resuscitation in septic pt’s
- b/c this time usually coincide w/ the time for emergency sx
Sepsis/SIRS: Anesthesia management
Volume resuscitation using crystalloids or colloids should be used initially, aiming to to reach the following clinical endpoints… give the goal values
- CVP:
- MAP:
- UOP:
- Central Venous Oxygen saturation:
- 8-12 mmHg
- 65 mmHg
- 0.5 mL/kg
- 70%
Sepsis/SIRS: Anesthesia management
Vasopressor support w/ _______ may be considered even b4 optimal IV fluid loading has been achieved.
Norepinephrine
Sepsis/SIRS: Anesthesia management
low dose _____ may be subsequently added to Norepinephrine to reduce the requirement for high doses of Levophed
Vasopressin
Sepsis/SIRS: Anesthesia management
______ are added to volume resuscitation and vasopressors, if there is evidence of continued low CO despite adequate cardiac filling and fluid resuscitation
Inotropes
Sepsis/SIRS: Anesthesia management
Resuscitation efforts should be continued as long as hemodynamic improvement accompies each step in the process, Further IV fluid administration shoul dbe stopped when?
filling pressures are high
and no further improvements in tissue perfusion is seen
Sepsis/SIRS: Anesthesia management
what happens to MAC in severe sepsis
Decreased
Sepsis/SIRS: Anesthesia management
the goal of mechanically ventilating pt’s w/ severe sepsis is to use ____ FiO2 concentrations
High
Sepsis/SIRS: Anesthesia management
there is evidence supporting the use of Low tidal volume ventilation, why is ths benificial
- Minimize the impact of positive pressure ventilation on lung tisuue
- minimize effcts on venous return and CO
Sepsis/SIRS: Anesthesia management
oxygenation may be impaired by non-cardiogeic pulmonary edema, which is caused by what?
Increaased capillary permeability
Sepsis/SIRS: Anesthesia management
Management options for hypoxemia during anesthesia include what tech
- Increasing Fio2
- Increasing PEEP
Thank you nigger
i mean mike… no i mean nigger
