Wk 27: Septic shock Flashcards
Who is at an increased risk of sepsis?
- < 1 yr + >75
- Impaired immune system
- Surgery w/in last 6 wks
- Breach skin integrity
- Misuse of IV drugs
- Indwelling lines/catheters
Define septic shock
Sepsis w/ persistent hypotension requiring vasopressors to maintain MAP ≥ 65mmHg + serum lactate >2mmol/L despite adequate fluid resuscitation
How is sepsis diagnosed?
History taking + clinical signs
- BP, O2 sats
- Assessment tools - SOFA, qSOFA, NEWS
What are signs + symptoms of sepsis?
- Fever
- Hypothermia
- HR >90
- Tachypnoea
- Oedema
- Hyperglycaemia in absence of diabetes
- Alt mental status
What do the signs + symptoms of sepsis progress into?
- Hypotension
- Cool peripheries + mottling
- Peripheral cyanosis
- Organ dysfunction
What is SIRS?
Multi-system response of body, 2/more:
- Tem > 38 or <36
– Tachycardia > 90 bpm
– Respiratory Rate > 20bpm
– WBC > 12 x109/L or < 4 x 109/L
What is SOFA?
Assesses organ dysfunction
- Respiratory system
- Coagulation
- Level of consciousness
- CV system
- Liver + renal function
What is the most common cause of sepsis?
Gram positive bacteria
What are the sepsis 6?
- Oxygen
- Cultures
- Fluids
- IV antibiotics
- Lactate
- Urine output
How much oxygen is recommended?
High flow oxygen - 15L/min
What cultures are required?
Blood, urine, stool + sputum
How are the antibiotics given?
- W/in 1 hr of admin - broad spec IV
- Review every 24-48 hrs
- Switch to oral asap
Why do you correct fluids?
- Improve cardiac output
- Prevent organ failure
How much fluid is given to a patient w/ sepsis?
- 500ml Hartmans in 15 mins or less
- 250ml if HF/CKD (IV/V)
How do you reassess the response to fluids?
- Urine output: >0.5ml/hr
- Pulse: <100bpm
- MAP: >65mmHg
