Test 1: Multisystem Dysfunction in ICU (Sepsis)

Question 1

Sepsis

Answer 1

A life threatening organ dysfunction caused by a deregulated host response ot infections. Must have a thing that causes it (infection, neuro damage, cardio damage, obstruction). Hypotension and Serum Lactate > 2

Question 2

Bacterimia

Answer 2

Presence of bacteria in blood. Not all with sepsis have bacterimia. Those with bacteremia CAN develop shock

Question 3

SIRS

Answer 3

Systemic inflammatory response syndrome:Any combination of these 4. Temp > 38 deg C or < 36 deg C, HR > 90bpm, RR > 20 breaths/min. WBC > 12,000

Question 4

qSOFA

Answer 4

sepsis detection (quick sequential sepsis related organ failure assessment).

Question 5

Sepsis Risk Factors

Answer 5

Affects all ages, especially those 65+ and <1; comorbidities (COPD, cancer, transplants); weakened immune system, previous sepsis, indwelling devices (ventilators, catheters, central lines)

Question 6

Sepsis signs and symptoms

Answer 6

Fever, tachycardia, tachypnea, other symptoms depend on location of original infection

Question 7

SEPSIS

Answer 7

S - shiver/fever; E - extreme pain; P - pale or discolored; S - sleepy, difficult to arouse, confused; I - “I feel like I might die”; S - shortness of breath

Question 8

Sepsis diagnosis

Answer 8

Biomarkers: blood lactate (shows systemic tissue hypoperfusion if > 2), C reactive protein (protein that indicates rapid increase in acute inflammation and infection), Procalcitonin (released in response to bacterial infection or tissue injury); Imaging can help determine initial location of infection

Question 9

Medical management

Answer 9

Hemodynamic Stabilization: Fluids and Vasoactive drugs (increase blood flow and blood pressure) to address blood lactace and hypotension; Infection Control: antibiotics and indentify the source

Question 10

Shock

Answer 10

Life threatening manifestation of circulatory failure (decreased O2 delivery and increased O2 consumption)

Question 11

Stages of Shock

Answer 11

Injury or infection -> Pre shock (compensated so immune system is working) -> Shock (symptoms present, immune system not working) -> End organ dysfunction (irreversible without intervention) -> Death

Question 12

Septic Shock

Answer 12

A type of distributive shock, sepsis symptoms become extreme, cascade effect; Hypotension -> poor organ profusion -> multisystem organ failure

Question 13

Anaphylactic Shock

Answer 13

A type of distributive shock, sever allergice reactioin and results in cardiovascular and respiratory distress (brought on by drugs, food, latex, insects)

Question 14

Neurogenic Shock

Answer 14

A type of distributive shock that mostly occurs in trauma to the brain or spinal cord, disrups autonomic pathway leading to impaired vagal tone

Question 15

Endocrine Shock

Answer 15

A type of distributive shock caused by adrenal failute leading to sudden drop in blood pressure

Question 16

Hypovolemic Shock

Answer 16

decreased intravascular volume; Hemorrhagic: GI bleed, rupture of anurysms; Non-hemorrhagic: organ losses (vomiting, diarrhea, drains, medication induced diuresis

Question 17

Cardiogenic Shock

Answer 17

Caused by intracardiac issues leading ot decreased CO and systemic hypoprofusion; Cardiomyopathies (MI and cardiac arrest), Arrhythmia, Mechanical (valve problem)

Question 18

Obstructive Shock

Answer 18

Caused by extracardiac issues leading to decreased CO; Pulmonary (PE) and Mechanical (pneumothorax, compression of LE causing decreased venous return)

Question 19

MD monitoring tools for shock

Answer 19

Apache 2 (used in first 24 hours, higher score is worse; 71 is highest); SOFA (used after 24 hours

Question 20

Effects of Bedrest on Cardiovascular+B44B19A31:B43A31:B46A31:B44A31:B45A31:B46A31:B44A31:B46A31:B45

Answer 20

Increased HR at rest, decreased resting and max stroke vol, decreased CO, increased risk for venous thrombosis, decreased orthostatic tolerance (upright tolerance), decreased aerobic conditioning, increased venous compliance (increased lower extremity pooling)

Question 21

Effects of Bedrest on Pulmonary

Answer 21

Pneumonia, increased secretions, decreased tidal volume, increased RR

Question 22

Effects of Bedrest on Skeletal

Answer 22

Disuse osteoporosis, decreased muscle mass, decreased strength, decreased endurance

Question 23

Effects of Bedrest on integumentart

Answer 23

pressure ulcers

Question 24

Effects of Bedrest on renal

Answer 24

Urinary calculi, urinary retention, overflow incontinence

Question 25

Effects of Bedrest on GI

Answer 25

Constipation

Question 26

Effects of Bedrest on endocrine

Answer 26

Glucose intolerance and insulin insensitivity

Question 27

ICUAW

Answer 27

ICU Acquired Weaknes (Also called critical illness myopathy or critical illness polyneuropathy): Diagnosis made in cases in which a patient is noted to have clinically detected weakness with no plausable cause

Question 28

ICUAW Risk factors

Answer 28

prolonged ventilation (as little at 3 days), sepsis or multiple system organ failure, high doses of corticosteroids and nuromuscular blocking agents.

Question 29

ICUAW Pathology

Answer 29

Results from cascade effect of multi organ failure, thought to be a result of ischemia and muscular breakdown for protein use while body is inflammed, nerve damage from decreased O2 supply and nutrition, hyperglycemia results in decreased circulation to peripheral nerves, muscle weakness can occur in 4 days, muscle wasting in as little at 10 days

Question 30

ICUAW Prognosis

Answer 30

More severe -> poor prognosis; weakness can persist years after hospitalization

Question 31

PICS

Answer 31

Post ICU syndrome; Cognitive symptoms (poor memory, problem solving, concentration), emotional (PTSD, anxiety, depression), Physical (fatigue, weakness, insomnia)

Question 32

ICUAW Prevention

Answer 32

Interruption of sedation paired with PT/OT in early illness was safe, and resulted in better outcomes at discharge, shorter duration of delirium, and more ventilator free days compared to standard care. Low adverse events with early mobilization

Question 33

ABCDEF Bundle

Answer 33

An evidence based guide for clinicians to approach the organizational changes needed to optimize ICU patient recovery outcomes. A- Assess, prevent and manage pain; B - Both spontaneous awakening trials and spontaneous breathing trials; C - choice of analgesia and sedation; D - Delirium (assess, prevent, manage); E - early mobility and exercise; F - family engagement and empowerment

Question 34

When does mobility begin?

Answer 34

As soon as acute crisis is stabilized, the patient is trending in the recovery direction, the A-F bundle is being applied.