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32 Cards in this Set
- Front
- Back
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define septic chock
what mediates it |
SHock: hypotension, hypoperfusion, disrodered tem regulation
Endotoxins: all gram - bacteria. part of cell membrane Exotoxin: made by bug |
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what bug causes most cases of sepsis
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Gram-
E coli most common klebsiella pseudomonas **these bugs come from pulm, GI, GU Gram + is less common but is caused by strep and staph when it does happen |
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what is the mortality of sepsis
what is the mortality of septic shock |
sepsis 10%
septic shock 40-60% |
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whats the pathophys/progression of sepsis to septic shock
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sepsis is just bug in blood
shock is when endo toxin from gram - does its thing - stim macro to release TNF like sub called cachetin -activates compliment -coagulation - PG, LT, brady, thromboxane, |
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what q's are important to ask for pt w/sepsis
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SOB
chest pain confusion sudden change or associated w/.long illness fever? cough, sputum, dysuria/frequency skin lesion previous instrumentation- catheter, birth proesthetic device- shunt, catheter, heart valve |
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what predisposing condistions are importnat in sepsis
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DM
AIDS IV DA OLD/YOUNG Cacner no spleen (SS) |
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what are early sublte signs of shick
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unexplained changes in mental status
hypothermia poor feeding in infants tachypenia w/o pneumonia |
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what are the vitals in sepsis
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Fever is common but some (esp old and young are hypothermic- hypothermia is onmious sx)
SEPSIS: normal or high SP w/ wide PP Shock: Hypotension, narrow pP Respirations go from normal RR to rapid and shallow Tachypenia |
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what are skin changes in septic pt
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warm skin with HYPOtension
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what are the 5 basic mecs of action for skin changes in septic pt
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1. DIC
2. vascular invasion/occlusion of BV w/bug 3. immune complex vasculitis 4. endocardic emboli 5. vasuclar effects of toxins skin will be warm and hypotensive *petechia, purpura, ecchymoses |
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what does DIC look on PE for sepsis
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bleeding for venipuncture
*non blanching acrocyanosis that progresses to ecchymoses, thse bloster and necrose into symmetric peripheral gangrene |
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what skin changes occur w/niserria
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well we have DIC htat is a non blanching acrocyanosis that progresses to ecchymosus and then to a necrotic blister
at the blister stage it changes names to symmetric peripheral gangrene. its seen on the distal part of 2 or more extremities, its STERILE lesion caused by niserria Immune vasculitis, delayed maculopapular rash |
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wht are hte skin changes in TSS
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toxin mediated
diffuse rash that is macular erythema. BLANCES with pressure. clears and then peels, esp on hands/feet assocuated with pharyngitis, acute synovitis, and conjuntivitis |
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how is heart and lung helpful to determine type of sepsis
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Heart:
new murmur- bacterial endocarditis LiungsL UL rales- pulm , decreased fremitus pneumonia |
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intiial mgmt and preliminart ddx is based on WHAT 2 questions
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1. hemodynamically and mentally stable
2. what are potential sites of infection |
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what disease states can be confused with sepsis
they all have abnormal temp and hypotension |
1. Pericarditis, pancreatitis. Fever and hypotension
2. GI bleed, myxedema coma, DKA. hypothermic and hypotensive 3. malnourished: hypotensive, hypothermic 4. envirnemntal hypothermia is hypotensive 5. drugs: hypotherimia 6. septic pulm emboli: IVDA 7. endocrine |
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whats UA good for in a septic pt
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GREAT
super frequent source of infection |
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whats the CBC look like in a pt/sepsis
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leukocytosis is common, non specific
leukopenia is poor prognosis |
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whats SPG (symmetric peripheral gangrene)
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its when dic progresses from non blanching arcrocynaosis to a blisterine nasty ecchymosis
its seen on distal part of 2 or more extermities, caused by Nieserria, lesions are STERILE |
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what are hte chemistries in septic pt
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low bicarb
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in early sepsis whats BUN creat and LFT
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all increase in early sepsis
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what is coagulation testing like in septic pt
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risk of DIC so get PT PTT platelet count
peripheral smear will show fragmented red cells and decreased plates |
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when do you wu for DIC
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well DIC is a risk so we always order plate and PT, if it suggests DIC or if we have weird bleeding we get additional test
fibrinogen d dimer PRR |
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how do ABGs change in septic pt
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early: respiratory alkalosis
mid: milkd metabolic acidosis, hypoxic late: profound hypoxemia and acidosis |
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why gram stain a septic pt
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stain sputum, lesion, ascites, or pleural effusion
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lumbar puncture and sepsis
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do if mental status or meningial signs persist.
DO NOT PERFORM if: papilledema or bain injury/tumor is suspected. if you wait on LP STILL give AB |
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what cultures are done in septic pt
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done but dont come back in time for initial tx path
give AB, change if culture comes back weird |
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whats sepsis 2 to UTI like
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most common
preg women more liekly bc of stasis more common in old |
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whats sepsis 2 to pulm like
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second most common
common in neonates- toxoplasmosis, listeria, chlamydia Comminity acquired pneumonia- strep, h influ, s aureus |
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sepsis 2 to CNS
what is the organism in newborns adults old |
meningitis from truama, congenital things with skull
Newborn: e coli, GBS ADULTS: N meningitidis, H influenca OLD: listeria Fever, HA, meningismus. vomit. altered mental status |
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sepsis. airway, vent support
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vent early bc of mental status
ARDS is most common cause of death |
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wht AB are used in sepsis
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aminoglycoside
b lactam adn other if you think anaerobic |
