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Bioscience II Brandon > SIRS/Sepsis ppt-josh > Flashcards

SIRS/Sepsis ppt-josh Flashcards

1
Q

WHO IS THE ONLY WHITE PERSON MIKE LIKES

A

Hippocrates

(prob b/c he’s dead)

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2
Q

Sepsis is the 2nd leading cause of death in the non-coronary ICU pt’s, dispite inproved care, mortality remains b/t __-__%

A

30-50%

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3
Q

what is the systemic inflammatory response to a wide variety of severe clinical insults

A

SIRS

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4
Q

SIRS:

is manifested by TWO or MORE of the following conditions!! what are those 4 conditions???

A
  1. Temp >38 C or < 36 C
  2. HR > 90 bpm
  3. RR > 20 bpm (or PaCO2 < 32)
  4. WBC- >12,000 or < 4,000 (or >10% bands)

basically is i walk to the mailbox i get SIRS

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5
Q

WHat is a systemic inflammatory response to an insult to a host, in association w/ infection.

A

Sepsis:

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6
Q

Sepsis:

what are the clinical manifestations for Sepsis:

A

same as for SIRS

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7
Q

Sepsis vs SIRS

is they manifest themselves the same how do you differentiate them?

A

Sepsis:- includes 2 or more of the mentioned conditions but 2ndary to a documented infection

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8
Q

Sepsis:

severe sepsis is associated w/ what 2 things?

A

Organ dysfunction

or hypotension

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9
Q

Severe Sepsis:

S/s

A
  • Hypoperfusion and perfusion abnormalities may include
  1. Lactic acidosis
  2. oliguria
  3. AMS
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10
Q

Sepsis:

What are examples of potent stimulus for activation of an inflammatory response (4)

A
  • trauma
  • Surgery
  • Organ dysfuntion
  • Infection w/ microorganisms or viruses
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11
Q

Sepsis:

SO what is the patho for this?

A

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

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12
Q

Sepsis:

what are some of the biochemical markers

A
  • Cytolines
  • TNF-a
  • IL-1-6-8
  • PAF
  • Prostaglandins
  • Leukotrienes
  • Neutrophil
  • Complement system
  • Vascular endothelial cells
  • Clotting and kinin cascades
  • Thromboxane
  • prostacyclin
  • prostaglandin
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13
Q

Sepsis:

what is the effect that the biomarkers couse in the body

A
  • Vasodilation
  • Incrreased Capillary Permeability
  • Cellular activation
  • Coagulopathy
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14
Q

Sepsis/SIRS: Anesthesia management

what is the central treatment to sucessful treatment of a pt w/ severe sepsis

A

Srugical removal of impurity

early antimicrobial therapy

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15
Q

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%

A

hemodynamic

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16
Q

SvO2:

what is it?

A

saturated venous oxygen

17
Q

SvO2:

has an _____ relationship to oxygen utilization in fully saturated blood!

A

Inverse

(lower SvO2: is the more O2 used)

18
Q

SvO2:

has a _____ relationship to CO and Hemoglobin

A

Direct

(one goes up the other goes up as well)

19
Q

SvO2:

w/ constant O2 consumption, mixed venous O2 saturation demonstrates the balance b/t what?

A

Oxygen delivery and oxygen demand

20
Q

SvO2:

SvO2 is the result of O2 consumption @ the ____ level!

A

Tissue

21
Q

SvO2:

it is the result os O2 consumption at the tissue level. this is measured as the _________

A

Oxygen Extraction Ration ( O2ER)

22
Q

SvO2:

What is the Normal O2ER value

A

24-28%

23
Q

SvO2:

what is the Calculation for the O2ER?

A

O2ER = SaO2 - SvO2 / SaO2

  • SaO2 - Arterial O2 sat
  • SvO2 - mixed venous O2 sat
24
Q

SvO2:

does a normal SvO2 alone show the status of specific organ perfusion

A

Nope

25
Q

SvO2:

is SvO2 alone adequate representation of tissue perfusion in pt’s w/ sepsis?

A

Again no fucking way

26
Q

what is the “Golden Hours” of sepsis, and why is this important to us?

A
  • the first 6 hours of resuscitation in septic pt’s
  • b/c this time usually coincide w/ the time for emergency sx
27
Q

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

  1. CVP:
  2. MAP:
  3. UOP:
  4. Central Venous Oxygen saturation:
A
  1. 8-12 mmHg
  2. 65 mmHg
  3. 0.5 mL/kg
  4. 70%
28
Q

Sepsis/SIRS: Anesthesia management

Vasopressor support w/ _______ may be considered even b4 optimal IV fluid loading has been achieved.

A

Norepinephrine

29
Q

Sepsis/SIRS: Anesthesia management

low dose _____ may be subsequently added to Norepinephrine to reduce the requirement for high doses of Levophed

A

Vasopressin

30
Q

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

A

Inotropes

31
Q

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?

A

filling pressures are high

and no further improvements in tissue perfusion is seen

32
Q

Sepsis/SIRS: Anesthesia management

what happens to MAC in severe sepsis

A

Decreased

33
Q

Sepsis/SIRS: Anesthesia management

the goal of mechanically ventilating pt’s w/ severe sepsis is to use ____ FiO2 concentrations

A

High

34
Q

Sepsis/SIRS: Anesthesia management

there is evidence supporting the use of Low tidal volume ventilation, why is ths benificial

A
  • Minimize the impact of positive pressure ventilation on lung tisuue
  • minimize effcts on venous return and CO
35
Q

Sepsis/SIRS: Anesthesia management

oxygenation may be impaired by non-cardiogeic pulmonary edema, which is caused by what?

A

Increaased capillary permeability

36
Q

Sepsis/SIRS: Anesthesia management

Management options for hypoxemia during anesthesia include what tech

A
  • Increasing Fio2
  • Increasing PEEP
37
Q

Thank you nigger

A

i mean mike… no i mean nigger

Bioscience II Brandon (11 decks)

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