Test 2 Sepsis

Question 1

SIRS
what is that
5 Criteria

Answer 1

Systemic Inflammatory Response Syndrome

• T: >38 C (100.4 F)
• RR: >20 bpm (PaC02 <32 mm Hg)
• HR: >90 bpm
• WBC: >12,000/mm³ or <4000/mm³

2 out 5 Criteria

Question 2

What is Sepis

Answer 2

Mortality 25 to 30%
Infection + SIRS response 2/5

Question 3

Sever Sepsis

Answer 3

Sepsis +
Infection induced organ Dysfunction /Hypoperfusion

Question 4

Septic Shock

Answer 4

• Refractory Hypotension despite adequate IV fluids
• Persistent Hypotension after Fluid resecitation With infection

Question 5

Three components to host response early sepsis

Answer 5

1. Immune system
2. Activation of inflammatory cascade
3. Alterations in Hemostais

Question 6

Immune System activation

Answer 6

**Innate immune system **
Immediate proteciton 1st minutes to 1st hours to recognize infection
**Adaptive Immune System Goal
**Aplifies innate immune system
Stimulate cell mediated and humoral system:
T cells (T 1 and T 2)
B cells ( inhance recognition )

Question 7

Iflammatory Cascades

Answer 7

**Proinflammmatory **
Cytokines activated: monocytes, neurophils,
Fever, Hypotension.
**Antinflammatory cytokines **

Question 8

Hemostatic Balance

Answer 8

Alteration of pro-coagultion factors
Decrease in Antigoagulant factors

Question 9

Extrinsic Pathway

Answer 9

**Factor VII **
Throbin (Conversion Fibrinogen to Fiber)

Question 10

Intrinsic Pathway

Answer 10

Activates Factor XI
Amplifies Coagulation
Further Formation of Thrombin

Question 11

Inhibit antigulation cascade

Answer 11

Inhibited (decrease) Antithrombin III and Protein C anD S
Procoagulant state (Decrease)

Question 12

Activation of Coagulation Cascade

Answer 12

Consumption of Coagulation Factors

Question 13

Dissenminated Intravascular Coagulation (DIC

Answer 13

**Excessive formatio of Fibrin
Suprssed Fibrinolysis

Leading To
Microthrombi and Ogran Failure

Question 14

DIC clinical Findings

Answer 14

• Gangrene
• Purpura Fulminans
• Bleeding

Question 15

Scoring to assess complicatio of SEPSIs

Answer 15

APACHE
Assess organ dysfunction

Question 16

Sepsis
Hypovolemic shock

Answer 16

Poor cardiac feeling

Question 17

Cardiogenic with sepsis

Answer 17

Infection induced myocardial function

Question 18

Distibutive Shock

Answer 18

Vasodilation (Widening ) with tissue hypoperfusion
Loss of peripheral resistnanse

Question 19

TX sepsis

Answer 19

**LA **
> 4 poor (
> LA is adequcy of tissue perfusion and anaerobic glycolisis
> Do not di-escalate antibiotics until organism identified and pt conditon has been iproved

BS b/w 80 to 110
* Rapid Crystalloid Administration : 30ml/kg
* Albumin after Crystalloid IV not working

Question 20

Quantitative Resuscitation

Answer 20

CVP 8-12 mm Hg
SV02 >70%
MAP > 65 mm Hg

Question 21

Vasoactive Agent

Answer 21

Norepinephrine
Epinephrine
Vasopressing
Dopamine
Phenylephrine

Question 22

Catecholamine Agent

Answer 22

Alpha and Beta

Question 23

Alpha 1 Adrenergic receptors

Answer 23

Vasocontriction ( it’s in blood vessels )

Question 24

Beta 1 Adrenergic Receptos

Answer 24

Increase HR and Myocadial Contractivity

Question 25

Beta 2 adrenergic Receptos

Answer 25

Peripheral Vasodilation

Question 26

Curret BP support for sepsis

Answer 26

Norepinephrine Add Epinephrine or Vasopressin

Question 27

Inopropic Support

Answer 27

Dobutamine Cardiac index : >/= 3.0L

Answer 28

**Hydrocortisone 200 mg/day** * 50 mg IV q6h or * 50 mg bolus, then 200 mg continuous infusion over 24 hours

Question 29

Vent setting recommendation

Answer 29

* **Recommended target tidal volume** 6 mL/kg predicted body weight with ARDS **Upper limit goal for plateau pressures** 30 cm H20 over higher plateau pressures **Higher PEEP over lower PEEP** **Prone over Supine positioning** **Recommended for PaO2/Fi02 ratio <150 ** Neuromuscular blocking agents Conservative fluid strategy If no evidence of tissue hypoperfusion Maintaining HOB of 30 to 45 degrees : limit aspiratio risk **** Limit aspiration ris Prevent VAP Weaning protocol & spontaneous breathing trials