Test 2 Sepsis Flashcards
SIRS
what is that
5 Criteria
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
What is Sepis
Mortality 25 to 30%
Infection + SIRS response 2/5
Sever Sepsis
Sepsis +
Infection induced organ Dysfunction /Hypoperfusion
Septic Shock
- Refractory Hypotension despite adequate IV fluids
- Persistent Hypotension after Fluid resecitation With infection
Three components to host response early sepsis
- Immune system
- Activation of inflammatory cascade
- Alterations in Hemostais
Immune System activation
**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 )
Iflammatory Cascades
**Proinflammmatory **
Cytokines activated: monocytes, neurophils,
Fever, Hypotension.
**Antinflammatory cytokines **
Hemostatic Balance
Alteration of pro-coagultion factors
Decrease in Antigoagulant factors
Extrinsic Pathway
**Factor VII **
Throbin (Conversion Fibrinogen to Fiber)
Intrinsic Pathway
Activates Factor XI
Amplifies Coagulation
Further Formation of Thrombin
Inhibit antigulation cascade
Inhibited (decrease) Antithrombin III and Protein C anD S
Procoagulant state (Decrease)
Activation of Coagulation Cascade
Consumption of Coagulation Factors
Dissenminated Intravascular Coagulation (DIC
**Excessive formatio of Fibrin
Suprssed Fibrinolysis
Leading To
Microthrombi and Ogran Failure
DIC clinical Findings
- Gangrene
- Purpura Fulminans
- Bleeding
Scoring to assess complicatio of SEPSIs
APACHE
Assess organ dysfunction
Sepsis
Hypovolemic shock
Poor cardiac feeling
Cardiogenic with sepsis
Infection induced myocardial function
Distibutive Shock
Vasodilation (Widening ) with tissue hypoperfusion
Loss of peripheral resistnanse
TX sepsis
**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
Quantitative Resuscitation
CVP 8-12 mm Hg
SV02 >70%
MAP > 65 mm Hg
Vasoactive Agent
Norepinephrine
Epinephrine
Vasopressing
Dopamine
Phenylephrine
Catecholamine Agent
Alpha and Beta
Alpha 1 Adrenergic receptors
Vasocontriction ( it’s in blood vessels )
Beta 1 Adrenergic Receptos
Increase HR and Myocadial Contractivity
Beta 2 adrenergic Receptos
Peripheral Vasodilation
Curret BP support for sepsis
Norepinephrine Add
Epinephrine or Vasopressin
Inopropic Support
Dobutamine
Cardiac index : >/= 3.0L
Hydrocortisone 200 mg/day
- 50 mg IV q6h or
- 50 mg bolus, then 200 mg continuous infusion over 24 hours
Vent setting recommendation
-
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
