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54 Cards in this Set
- Front
- Back
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Myocardial depression is present in early septic shock. but why?
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Significant evidence points toward the existence of several active circulating myocardial depressant substances.
Substances that have demonstrated myocardial depressant activity include TNF-α (when IL-1β is present), nitric oxide, PAF, oxygen free radicals, interferon-γ, and arachidonic acid metabolites. The compounds that have received the most scrutiny are the combination of TNF-α, IL-1β, and nitric oxide. |
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Liver dysfunction is frequently seen in patients with sepsis; the most frequent abnormality is
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cholestatic jaundice. Increases in transaminase, alkaline phosphatase (one to three times normal), and bilirubin concentrations (usually not >10 mg/dL) are frequently noted. The proposed mechanism for bilirubin elevation involves hemolysis of red blood cells and hepatocellular dysfunction due to endotoxin, cytokines, or immune complex disease. Prolonged or severe hypotension may induce acute hepatic injury or ischemic bowel necrosis.
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Liver dysfunction is frequently seen in patients with sepsis; the most frequent abnormality is
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cholestatic jaundice. Increases in transaminase, alkaline phosphatase (one to three times normal), and bilirubin concentrations (usually not >10 mg/dL) are frequently noted. The proposed mechanism for bilirubin elevation involves hemolysis of red blood cells and hepatocellular dysfunction due to endotoxin, cytokines, or immune complex disease. Prolonged or severe hypotension may induce acute hepatic injury or ischemic bowel necrosis.
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The most frequent hematologic changes in the septic patient are
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neutropenia or neutrophilia, thrombocytopenia, and disseminated intravascular coagulation (DIC).
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Blood gas analysis performed early in the course of septic shock usually finds
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respiratory alkalosis
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Septic shock should be suspected in any individual with a temperature of what and a BP of what
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above 38°C or below 36°C systolic blood pressure below 90 mm Hg with evidence of inadequate organ perfusion.
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Septic shock should be suspected in any individual with a temperature of what and a BP of what
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above 38°C or below 36°C systolic blood pressure below 90 mm Hg with evidence of inadequate organ perfusion.
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the hypotension of septic shock is characterized by
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The hypotension should not reverse with rapid volume replacement of at least 1 L of isotonic crystalloid.
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the hypotension of septic shock is characterized by
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The hypotension should not reverse with rapid volume replacement of at least 1 L of isotonic crystalloid.
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The differential diagnosis of septic shock includes
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other nonseptic causes of shock such as cardiogenic, hypovolemic, anaphylactic, neurogenic, obstructive (pulmonary embolism, tamponade), and endocrine (adrenal insufficiency, thyroid storm) causes. articular attention should be focused on infections in these organ systems: central nervous system, pulmonary, intra-abdominal, urinary tract, skin, and soft tissue.
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The differential diagnosis of septic shock includes
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articular attention should be focused on infections in these organ systems: central nervous system, pulmonary, intra-abdominal, urinary tract, skin, and soft tissue.
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The differential diagnosis of septic shock includes
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articular attention should be focused on infections in these organ systems: central nervous system, pulmonary, intra-abdominal, urinary tract, skin, and soft tissue.
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the primary considerations for the biliary tree. in septic shock
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Suppurative cholangitis and empyema of the gallbladder are the primary considerations for the biliary tree.
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the primary considerations for the biliary tree. in septic shock
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Suppurative cholangitis and empyema of the gallbladder are the primary considerations for the biliary tree.
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what to consider is women of childbearing age presenting with septic shock
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In women of childbearing age, septic abortion and postpartum endometritis or myometritis are the dominating presenting infections leading to septic shock.
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what to consider is women of childbearing age presenting with septic shock
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In women of childbearing age, septic abortion and postpartum endometritis or myometritis are the dominating presenting infections leading to septic shock.
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Cholangitis is defined as
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inflammation of the bile ducts. In half to two thirds of cases, it is characterized clinically by Charcot’s triad (pain in the right upper quadrant of the abdomen, fever, and jaundice)
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Cholangitis is defined as
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inflammation of the bile ducts. In half to two thirds of cases, it is characterized clinically by Charcot’s triad (pain in the right upper quadrant of the abdomen, fever, and jaundice)
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what are the predominant bugs of cholangitis and how to they arrive
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the E.Faecalis, enterococci, and klebsiella are though to arrive by way of the portal vein
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Primary sclerosing cholangitis is characterized by
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ongoing inflammation, destruction, and fibrosis of the intrahepatic and extrahepatic bile ducts.6 The cause of this disorder remains unknown. Over time, the bile ducts become irregularly narrowed and obliterated, and focal dilatation proximal to areas of stricture pro- duces a characteristic beaded appearance on cholangi- ographic examination. The disease progresses silently but relentlessly in most patients and leads to cirrhosis, portal hypertension, and liver failure.
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Primary sclerosing cholangitis is characterized by
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ongoing inflammation, destruction, and fibrosis of the intrahepatic and extrahepatic bile ducts.6 The cause of this disorder remains unknown. Over time, the bile ducts become irregularly narrowed and obliterated, and focal dilatation proximal to areas of stricture pro- duces a characteristic beaded appearance on cholangi- ographic examination. The disease progresses silently but relentlessly in most patients and leads to cirrhosis, portal hypertension, and liver failure.
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Primary sclerosing cholangitis is characterized by
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ongoing inflammation, destruction, and fibrosis of the intrahepatic and extrahepatic bile ducts.6 The cause of this disorder remains unknown. Over time, the bile ducts become irregularly narrowed and obliterated, and focal dilatation proximal to areas of stricture pro- duces a characteristic beaded appearance on cholangi- ographic examination. The disease progresses silently but relentlessly in most patients and leads to cirrhosis, portal hypertension, and liver failure.
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Caroli’s disease is a rare disorder resulting from
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con- genital dilatation of the large intrahepatic bile ducts.15 The disorder is usually silent for 5 to 20 years after birth but subsequently becomes manifest after an ep- isode of bacterial cholangitis.
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Caroli’s disease is a rare disorder resulting from
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con- genital dilatation of the large intrahepatic bile ducts.15 The disorder is usually silent for 5 to 20 years after birth but subsequently becomes manifest after an ep- isode of bacterial cholangitis.
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. The most common cause of cholangitis in Hong Kong and southern Chi- na is
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recurrent pyogenic cholangitis, also known as “in- trahepatic stone disease” and “Oriental cholangiohep- atitis.”
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The cause of recurrent pyogenic cholangitis is un- known, although the disease originates
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in the intrahe- patic bile ducts. Bacterial infection of the biliary tree by way of the portal vein is postulated to be the cru- cial, if not the inciting, event. The enteric bacteria that enter the biliary tract possess b-glucuronidase activity and cause the deconjugation of bilirubin glucuronide. The deconjugated bilirubin precipitates with calcium in the bile and forms insoluble calcium bilirubinate or bilirubin-pigment stones, which are characteristically soft, brown, and friable.23,24 Intrahepatic stone forma- tion is then thought to initiate a cycle of recurrent cho- langitis and the formation of additional stones.
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The cause of recurrent pyogenic cholangitis is un- known, although the disease originates
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in the intrahe- patic bile ducts. Bacterial infection of the biliary tree by way of the portal vein is postulated to be the cru- cial, if not the inciting, event. The enteric bacteria that enter the biliary tract possess b-glucuronidase activity and cause the deconjugation of bilirubin glucuronide. The deconjugated bilirubin precipitates with calcium in the bile and forms insoluble calcium bilirubinate or bilirubin-pigment stones, which are characteristically soft, brown, and friable.23,24 Intrahepatic stone forma- tion is then thought to initiate a cycle of recurrent cho- langitis and the formation of additional stones.
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The most prevalent etiologies of primary bacteremias in outpatients are
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S. aureus, S. pneumoniae, and N. meningitidis. Encapsulated species such as Salmonella or H. influenzae are important pathogens in individuals who are asplenic. Pseudomonas aeruginosa and other gram-negative bacteria are occasional etiologies of bacteremia and endocarditis in injection drug users.
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The most prevalent etiologies of primary bacteremias in outpatients are
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S. aureus, S. pneumoniae, and N. meningitidis. Encapsulated species such as Salmonella or H. influenzae are important pathogens in individuals who are asplenic. Pseudomonas aeruginosa and other gram-negative bacteria are occasional etiologies of bacteremia and endocarditis in injection drug users.
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basic lab studies for the potentially septic patient in the er
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Basic laboratory studies should include a complete blood count including platelet count; DIC panel (prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, ATIII concentration); serum electrolytes (including magnesium, calcium, phosphate, and glucose); liver function panel (bilirubin, alkaline phosphate, and alanine aminotransferase); renal function panel (blood urea nitrogen and creatinine); arterial blood gas analysis; and urinalysis. Blood should be typed and crossed if low hematocrit is suspected. A chest radiograph should be part of the basic evaluation. Flat and upright abdominal films are helpful in patients in whom there is a potential abdominal source of infection and should be considered in every patient except individuals with a completely benign abdomen or an obvious alternate source. Any patient with a clinical presentation compatible with meningitis should undergo a lumbar puncture with cerebrospinal fluid collected for analysis without delay in the emergency department. In individuals with papilledema, focal neurologic deficits, or the potential for brain abscess or epidural or subdural empyema, the lumbar puncture should be deferred until an imaging study is performed. However, if meningitis is an important consideration, empiric antimicrobial therapy should be initiated prior to the imaging study.
Bacterial cultures of blood and urine should be obtained from all septic patients. At least two separate sets of blood cultures from different venipuncture sites should be obtained. Gram stain and culture of secretions from any potential site of infection should be performed. Gram stain and other means of rapid identification of microbial etiologies are generally the only immediately available tests useful in selection of antimicrobial therapy. |
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basic lab studies for the potentially septic patient in the er
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Basic laboratory studies should include a complete blood count including platelet count; DIC panel (prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, ATIII concentration); serum electrolytes (including magnesium, calcium, phosphate, and glucose); liver function panel (bilirubin, alkaline phosphate, and alanine aminotransferase); renal function panel (blood urea nitrogen and creatinine); arterial blood gas analysis; and urinalysis. Blood should be typed and crossed if low hematocrit is suspected. A chest radiograph should be part of the basic evaluation. Flat and upright abdominal films are helpful in patients in whom there is a potential abdominal source of infection and should be considered in every patient except individuals with a completely benign abdomen or an obvious alternate source. Any patient with a clinical presentation compatible with meningitis should undergo a lumbar puncture with cerebrospinal fluid collected for analysis without delay in the emergency department. In individuals with papilledema, focal neurologic deficits, or the potential for brain abscess or epidural or subdural empyema, the lumbar puncture should be deferred until an imaging study is performed. However, if meningitis is an important consideration, empiric antimicrobial therapy should be initiated prior to the imaging study.
Bacterial cultures of blood and urine should be obtained from all septic patients. At least two separate sets of blood cultures from different venipuncture sites should be obtained. Gram stain and culture of secretions from any potential site of infection should be performed. Gram stain and other means of rapid identification of microbial etiologies are generally the only immediately available tests useful in selection of antimicrobial therapy. |
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basic lab studies for the potentially septic patient in the er
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Basic laboratory studies should include a complete blood count including platelet count; DIC panel (prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, ATIII concentration); serum electrolytes (including magnesium, calcium, phosphate, and glucose); liver function panel (bilirubin, alkaline phosphate, and alanine aminotransferase); renal function panel (blood urea nitrogen and creatinine); arterial blood gas analysis; and urinalysis. Blood should be typed and crossed if low hematocrit is suspected. A chest radiograph should be part of the basic evaluation. Flat and upright abdominal films are helpful in patients in whom there is a potential abdominal source of infection and should be considered in every patient except individuals with a completely benign abdomen or an obvious alternate source. Any patient with a clinical presentation compatible with meningitis should undergo a lumbar puncture with cerebrospinal fluid collected for analysis without delay in the emergency department. In individuals with papilledema, focal neurologic deficits, or the potential for brain abscess or epidural or subdural empyema, the lumbar puncture should be deferred until an imaging study is performed. However, if meningitis is an important consideration, empiric antimicrobial therapy should be initiated prior to the imaging study.
Bacterial cultures of blood and urine should be obtained from all septic patients. At least two separate sets of blood cultures from different venipuncture sites should be obtained. Gram stain and culture of secretions from any potential site of infection should be performed. Gram stain and other means of rapid identification of microbial etiologies are generally the only immediately available tests useful in selection of antimicrobial therapy. |
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basic lab studies for the potentially septic patient in the er
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Basic laboratory studies should include a complete blood count including platelet count; DIC panel (prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, ATIII concentration); serum electrolytes (including magnesium, calcium, phosphate, and glucose); liver function panel (bilirubin, alkaline phosphate, and alanine aminotransferase); renal function panel (blood urea nitrogen and creatinine); arterial blood gas analysis; and urinalysis. Blood should be typed and crossed if low hematocrit is suspected. A chest radiograph should be part of the basic evaluation. Flat and upright abdominal films are helpful in patients in whom there is a potential abdominal source of infection and should be considered in every patient except individuals with a completely benign abdomen or an obvious alternate source. Any patient with a clinical presentation compatible with meningitis should undergo a lumbar puncture with cerebrospinal fluid collected for analysis without delay in the emergency department. In individuals with papilledema, focal neurologic deficits, or the potential for brain abscess or epidural or subdural empyema, the lumbar puncture should be deferred until an imaging study is performed. However, if meningitis is an important consideration, empiric antimicrobial therapy should be initiated prior to the imaging study.
Bacterial cultures of blood and urine should be obtained from all septic patients. At least two separate sets of blood cultures from different venipuncture sites should be obtained. Gram stain and culture of secretions from any potential site of infection should be performed. Gram stain and other means of rapid identification of microbial etiologies are generally the only immediately available tests useful in selection of antimicrobial therapy. |
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basic lab studies for the potentially septic patient in the er
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Basic laboratory studies should include a complete blood count including platelet count; DIC panel (prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, ATIII concentration); serum electrolytes (including magnesium, calcium, phosphate, and glucose); liver function panel (bilirubin, alkaline phosphate, and alanine aminotransferase); renal function panel (blood urea nitrogen and creatinine); arterial blood gas analysis; and urinalysis. Blood should be typed and crossed if low hematocrit is suspected. A chest radiograph should be part of the basic evaluation. Flat and upright abdominal films are helpful in patients in whom there is a potential abdominal source of infection and should be considered in every patient except individuals with a completely benign abdomen or an obvious alternate source. Any patient with a clinical presentation compatible with meningitis should undergo a lumbar puncture with cerebrospinal fluid collected for analysis without delay in the emergency department. In individuals with papilledema, focal neurologic deficits, or the potential for brain abscess or epidural or subdural empyema, the lumbar puncture should be deferred until an imaging study is performed. However, if meningitis is an important consideration, empiric antimicrobial therapy should be initiated prior to the imaging study.
Bacterial cultures of blood and urine should be obtained from all septic patients. At least two separate sets of blood cultures from different venipuncture sites should be obtained. Gram stain and culture of secretions from any potential site of infection should be performed. Gram stain and other means of rapid identification of microbial etiologies are generally the only immediately available tests useful in selection of antimicrobial therapy. |
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Mild to moderately severe postpartum endometritis is treated with
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extended-spectrum penicillin (ticarcillin/clavulanic acid or ampicillin/sulbactam) or second-generation cephalosporin (cefotetan or cefoxitin). Severe pospartum endometritis can be treated with clindamycin and gentamicin, especially after cesarean delivery. Therapy should be continued until the patient is afebrile for 24 hours, is free of abdominal pain, and no longer has a leukocytosi
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Mild to moderately severe postpartum endometritis is treated with
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extended-spectrum penicillin (ticarcillin/clavulanic acid or ampicillin/sulbactam) or second-generation cephalosporin (cefotetan or cefoxitin). Severe pospartum endometritis can be treated with clindamycin and gentamicin, especially after cesarean delivery. Therapy should be continued until the patient is afebrile for 24 hours, is free of abdominal pain, and no longer has a leukocytosi
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should be obtained if septic abortion is suspected
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A complete blood count, urinalysis, endometrial cultures, blood cultures, chest x-ray, and abdominal x-ray to rule out uterine perforation should be obtained. Ultrasound may be helpful in ruling out retained products of conception.
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should be obtained if septic abortion is suspected
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A complete blood count, urinalysis, endometrial cultures, blood cultures, chest x-ray, and abdominal x-ray to rule out uterine perforation should be obtained. Ultrasound may be helpful in ruling out retained products of conception.
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should be obtained if septic abortion is suspected
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A complete blood count, urinalysis, endometrial cultures, blood cultures, chest x-ray, and abdominal x-ray to rule out uterine perforation should be obtained. Ultrasound may be helpful in ruling out retained products of conception.
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first priority in the management of sepsis
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oxygenation and ventilation status , most experts recommend maintaining oxygen saturations above 90 percent in a septic patient.
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first priority in the management of sepsis
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oxygenation and ventilation status , most experts recommend maintaining oxygen saturations above 90 percent in a septic patient.
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second goal of resuscitation in septic ptatient
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Correction or stabilization of hypotension and inadequate perfusion
apid fluid administration at a rate of 0.5 L (10 mL/kg in children) of normal saline or similar isotonic crystalloid should be administered every 5 to 10 min, as needed; it is not unusual for the patient to require 4 to 6 L (60 mL/kg in children) or more of crystalloid in the initial phase of resuscitation. Stabilization of the patient's mentation, blood pressure, respiration, pulse rate, skin perfusion, and central venous pressure, with urine output greater than 30 mL per h (1 mL/kg per h in pediatric patients) are useful clinical parameters in monitoring the response to fluid administration. |
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second goal of resuscitation in septic ptatient
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Rapid fluid administration at a rate of 0.5 L (10 mL/kg in children) of normal saline or similar isotonic crystalloid should be administered every 5 to 10 min, as needed; it is not unusual for the patient to require 4 to 6 L (60 mL/kg in children) or more of crystalloid in the initial phase of resuscitation. Stabilization of the patient's mentation, blood pressure, respiration, pulse rate, skin perfusion, and central venous pressure, with urine output greater than 30 mL per h (1 mL/kg per h in pediatric patients) are useful clinical parameters in monitoring the response to fluid administration.
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second goal of resuscitation in septic ptatient
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Rapid fluid administration at a rate of 0.5 L (10 mL/kg in children) of normal saline or similar isotonic crystalloid should be administered every 5 to 10 min, as needed; it is not unusual for the patient to require 4 to 6 L (60 mL/kg in children) or more of crystalloid in the initial phase of resuscitation. Stabilization of the patient's mentation, blood pressure, respiration, pulse rate, skin perfusion, and central venous pressure, with urine output greater than 30 mL per h (1 mL/kg per h in pediatric patients) are useful clinical parameters in monitoring the response to fluid administration.
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INOTROPIC SUPPORt should begin in the septic patient when
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If no response to the fluid infusion is noted after 3 to 4 L of fluid, or if there are signs of fluid overload (elevated central venous pressure or pulmonary edema), an infusion of dopamine can be started.11 If the patient has a pulmonary artery catheter in place during this resuscitation, dopamine should be added in the setting of a PAOP of 15 to 18 mm Hg or if there are marked increases of the PAOP with additional fluids. Doses of dopamine often required are 5 to 20 ug/kg per min, resulting in β1-adrenergic inotropic and α-adrenergic vasopressor activities. If the patient does not adequately respond to a rate of 20 ug/kg per min, norepinephrine should be started with the goal of keeping the mean blood pressure at least at 60 mm Hg. Once the blood pressure and perfusion have been stabilized by norepinephrine, the lowest dosage that maintains blood pressure should be used to minimize the complications of vasoconstriction. In addition, data from the canine model have suggested that the use of low-dose dopamine or dobutamine (1 to 4 ug/kg per min) in patients on norepinephrine results in significantly higher renal blood flow and reduced renal vascular resistance. The effect of norepinephrine on survival from septic shock is debatable, but survival rates of up to 40 percent have been reported
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INOTROPIC SUPPORt should begin in the septic patient when
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If no response to the fluid infusion is noted after 3 to 4 L of fluid, or if there are signs of fluid overload (elevated central venous pressure or pulmonary edema), an infusion of dopamine can be started.11 If the patient has a pulmonary artery catheter in place during this resuscitation, dopamine should be added in the setting of a PAOP of 15 to 18 mm Hg or if there are marked increases of the PAOP with additional fluids. Doses of dopamine often required are 5 to 20 ug/kg per min, resulting in β1-adrenergic inotropic and α-adrenergic vasopressor activities. If the patient does not adequately respond to a rate of 20 ug/kg per min, norepinephrine should be started with the goal of keeping the mean blood pressure at least at 60 mm Hg. Once the blood pressure and perfusion have been stabilized by norepinephrine, the lowest dosage that maintains blood pressure should be used to minimize the complications of vasoconstriction. In addition, data from the canine model have suggested that the use of low-dose dopamine or dobutamine (1 to 4 ug/kg per min) in patients on norepinephrine results in significantly higher renal blood flow and reduced renal vascular resistance. The effect of norepinephrine on survival from septic shock is debatable, but survival rates of up to 40 percent have been reported
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INOTROPIC SUPPORt should begin in the septic patient when
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If no response to the fluid infusion is noted after 3 to 4 L of fluid, or if there are signs of fluid overload (elevated central venous pressure or pulmonary edema), an infusion of dopamine can be started.11 If the patient has a pulmonary artery catheter in place during this resuscitation, dopamine should be added in the setting of a PAOP of 15 to 18 mm Hg or if there are marked increases of the PAOP with additional fluids. Doses of dopamine often required are 5 to 20 ug/kg per min, resulting in β1-adrenergic inotropic and α-adrenergic vasopressor activities. If the patient does not adequately respond to a rate of 20 ug/kg per min, norepinephrine should be started with the goal of keeping the mean blood pressure at least at 60 mm Hg. Once the blood pressure and perfusion have been stabilized by norepinephrine, the lowest dosage that maintains blood pressure should be used to minimize the complications of vasoconstriction. In addition, data from the canine model have suggested that the use of low-dose dopamine or dobutamine (1 to 4 ug/kg per min) in patients on norepinephrine results in significantly higher renal blood flow and reduced renal vascular resistance. The effect of norepinephrine on survival from septic shock is debatable, but survival rates of up to 40 percent have been reported
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INOTROPIC SUPPORt should begin in the septic patient when
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If no response to the fluid infusion is noted after 3 to 4 L of fluid, or if there are signs of fluid overload (elevated central venous pressure or pulmonary edema), an infusion of dopamine can be started.11 If the patient has a pulmonary artery catheter in place during this resuscitation, dopamine should be added in the setting of a PAOP of 15 to 18 mm Hg or if there are marked increases of the PAOP with additional fluids. Doses of dopamine often required are 5 to 20 ug/kg per min, resulting in β1-adrenergic inotropic and α-adrenergic vasopressor activities. If the patient does not adequately respond to a rate of 20 ug/kg per min, norepinephrine should be started with the goal of keeping the mean blood pressure at least at 60 mm Hg. Once the blood pressure and perfusion have been stabilized by norepinephrine, the lowest dosage that maintains blood pressure should be used to minimize the complications of vasoconstriction. In addition, data from the canine model have suggested that the use of low-dose dopamine or dobutamine (1 to 4 ug/kg per min) in patients on norepinephrine results in significantly higher renal blood flow and reduced renal vascular resistance. The effect of norepinephrine on survival from septic shock is debatable, but survival rates of up to 40 percent have been reported
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INOTROPIC SUPPORt should begin in the septic patient when
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If no response to the fluid infusion is noted after 3 to 4 L of fluid, or if there are signs of fluid overload (elevated central venous pressure or pulmonary edema), an infusion of dopamine can be started.11 If the patient has a pulmonary artery catheter in place during this resuscitation, dopamine should be added in the setting of a PAOP of 15 to 18 mm Hg or if there are marked increases of the PAOP with additional fluids. Doses of dopamine often required are 5 to 20 ug/kg per min, resulting in β1-adrenergic inotropic and α-adrenergic vasopressor activities. If the patient does not adequately respond to a rate of 20 ug/kg per min, norepinephrine should be started with the goal of keeping the mean blood pressure at least at 60 mm Hg. Once the blood pressure and perfusion have been stabilized by norepinephrine, the lowest dosage that maintains blood pressure should be used to minimize the complications of vasoconstriction. In addition, data from the canine model have suggested that the use of low-dose dopamine or dobutamine (1 to 4 ug/kg per min) in patients on norepinephrine results in significantly higher renal blood flow and reduced renal vascular resistance. The effect of norepinephrine on survival from septic shock is debatable, but survival rates of up to 40 percent have been reported
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There is good evidence for hemodynamic goal-directed therapy in sepsis and septic shock.15 Rivers and associates used a standardized protocol for
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Rivers and associates used a standardized protocol for fluid resuscitation, vasopressors, inotropes, mechanical ventilation, maintenance of central venous pressure between 8 and 12 mm Hg, hematocrit of 30 percent, and central venous oxygen saturation of at least 70 percent in 130 patients with severe sepsis and septic shock. They found a reduction in hospital mortality from 44% in the control group to 29% in the intervention group [absolute reduction 15%; 95% CI 3.6 to 26.6%].15 They concluded that early goal-directed therapy initiated in the emergency department provides significant benefit and improves outcome in patients with severe sepsis and septic shock.
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There is good evidence for hemodynamic goal-directed therapy in sepsis and septic shock.15 Rivers and associates used a standardized protocol for
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Rivers and associates used a standardized protocol for fluid resuscitation, vasopressors, inotropes, mechanical ventilation, maintenance of central venous pressure between 8 and 12 mm Hg, hematocrit of 30 percent, and central venous oxygen saturation of at least 70 percent in 130 patients with severe sepsis and septic shock. They found a reduction in hospital mortality from 44% in the control group to 29% in the intervention group [absolute reduction 15%; 95% CI 3.6 to 26.6%].15 They concluded that early goal-directed therapy initiated in the emergency department provides significant benefit and improves outcome in patients with severe sepsis and septic shock.
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There is good evidence for hemodynamic goal-directed therapy in sepsis and septic shock.15 Rivers and associates used a standardized protocol for
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Rivers and associates used a standardized protocol for fluid resuscitation, vasopressors, inotropes, mechanical ventilation, maintenance of central venous pressure between 8 and 12 mm Hg, hematocrit of 30 percent, and central venous oxygen saturation of at least 70 percent in 130 patients with severe sepsis and septic shock. They found a reduction in hospital mortality from 44% in the control group to 29% in the intervention group [absolute reduction 15%; 95% CI 3.6 to 26.6%].15 They concluded that early goal-directed therapy initiated in the emergency department provides significant benefit and improves outcome in patients with severe sepsis and septic shock.
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may help in the monitoring of fluid resuscitation
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Early placement of a central venous catheter (ideally with a 8.5-French catheter introducer)
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may help in the monitoring of fluid resuscitation
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Early placement of a central venous catheter (ideally with a 8.5-French catheter introducer)
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