Week 7 , Lecture C - Sepsis Flashcards

1
Q

What is SIRS

A


Clinical response arising from
nonspecific insult, including
2 or more of the following:

• Temperature =/>38oC or 90 beats/min
• Respirations =/>20/min
• WBC count =/> 12,000/mm3 or
4,000/mm3 or less than or >10% immature
neutrophils
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2
Q

What is sepsis

A

SIRS with a presumed
or confirmed
infectious process

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3
Q

What is severe sepsis?

A
Sepsis with 1 or more sign of organ
failure
Cardiovascular (refractory
hypotension)
Renal
Respiratory
Hepatic
Hematologic
CNS
Metabolic acidosis
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4
Q

Incidence and mortality for septic shock

A

Rare but death rate is 50%

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5
Q

Where can patients with sepsis come from?

A

Community and be admitted to ward or icu

or
may develop it while in hospital or ICU, especially if develops pneumonia

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6
Q

What is the management of septic shock?

A
 Early recognition
 Early haemodynamic resuscitation and continued
support
 Early and adequate antibiotic therapy
 Source control
 Tight glycaemic control
 Protective mechanical ventilation
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7
Q

Effect of infection on muscles

A

pro-inflammatory cytokines > intracellular mediators > catabolism or dysfunction > breaking down of muscle mass

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8
Q

Effect of immobilsation on muscles

A
 Muscles - not inactive partners
during immobility - work in
bidirectional role to
inflammatory signalling
 Proinflammatory state develops
with bed rest, with ­
production of reactive oxygen
species (ROS), and ¯ in antioxidative
defences
 Immobile muscles therefore
cause even more acute as well
as long term deleterious effects
to patient.
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9
Q

Why exercising ICU patient is good for their muscles

A

Exercise training - been shown to ¯ the local expression of
cytokines & inducible nitric oxide synthase (iNOS)
in muscle biopsies of CHF patients

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10
Q

Barriers to exercise in early stage septic shock

A
 Cardiovascular
instability
 High vasopressor
requirement
 Vasodilatation ie vasoplegic
 Respiratory instability
 Nitric oxide
 Invasive lines ++
 Heavy sedation
 Equipment ++
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11
Q

preliminary evidence early stage septic shock

A

Passive stretch = increased cognititon, decreased delirium, decreased length of stay

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12
Q

How can physio affect the prognosis of someone with sepsis

A
 We can make a difference in weakness
post ICU in sepsis by:
 Early passive exercise
 EMA
 Sitting on edge of bed
 Sitting up high
 Active assisted X’s as soon as able
 Early walking with equipment
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