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40 Cards in this Set
- Front
- Back
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def bacteremia
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presence of bacteria in the blood
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def sirs
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2 of the following
- > 38C (100.4 F) or <36 C (98.7 F) - hr > 90 beats/ min - resp rate > 20 beats/ min - wbc >12,000 or < 4,000/mm3 - bands > 10% |
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def sepsis
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- presense of infection
- have sirs criteria - + fever, hypotension |
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def severe sepsis
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- sepsis and 1 or more organ dysfxn
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def septic shock
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- severe sepsis and hypotension even w/ optimal fluid resusitation
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def mods
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- septic shock with 2 or more organ dysfxn
- acute lung injury - renal failure - hepatic failure -cardiac dysfxn |
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is bp in sirs criteria
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no
only temp, pulse, hr, wbc, bands |
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pathogenesis of sepsis
complex interactions b/t the host and the virulent org - host responses, give the types |
- immune response
- pro and inflammatory response - procoagulant response |
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pathogensis of sepsis
immune response |
- bacteria illicit an immune response by producing cell wall products
Cell wall products • Lipoteichoicacid –Gram positive bacteria • Lipopolysaccharide –Gram negative bacteria • Mannan –Fungi |
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pathogenesis of sepsis
pro inflam response |
• Macrophages and monocytes
–Release pro-inflammatory cytokines • TNF-alpha , interleukins –Activate coagulation cascade and block fibrinolysis • Cytokines and bradykinin –Induce inappropriate vasodilation • Inflammatory mediators can cause vasodilation, endothelial damage, and increased capillary permeability –Fluid shifting (third spacing) can lead to an increased in the volume of distribution |
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sepsis or sirs has the greatest risk of clots
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sirs
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pathogenesis of sepsis
procoagulant response |
• Alteration in procoagulantand anticoagulant
balance –Increase tissue factors • Activation of the coagulation cascade –Decrease anticoagulant factors • Protein C, protein S, antithrombinIII |
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t/f
fibrin cz clot --> clot will dislodge --> cz target organ damage |
true , give drugs to prevent this
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dic means
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Disseminated intravascular coagulation (DIC)
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def dic
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def frm ref:
Disseminated intravascular coagulation, or DIC, is a bleeding disorder resulting from the widespread overstimulation of the body's clotting and anticlotting mechanisms in response to illness, stress, or both. Disseminated intravascular coagulation (DIC) occurs mainly within the capillaries or the microcirculation. It is a secondary complication of a diverse group of disorders that activate, in some way, the coagulation system. dr. nguyens notes –Intravascular deposition of fibrin • Thrombosis of blood vessels leading to organ dysfunction –Depletion of platelets • Bleeding |
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causes of dic
main one |
• Sepsis (main)
• Trauma (2nd) • Cancer (3rd) • Obstetrical complications • Vascular disorders • Reactions to toxins • Immunologic disorders |
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5 diagnosis criteria for dic
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1) Thrombocytopenia
–<100,000 mm3 2) Prolongation of clotting time –Increase PT and aPTT 3) Increase fibrin-degradation 4) Depleted anticoagulants 5) Decrease fibrinogen –Acute-phase reactant |
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name the categories of clinical manifestations of sepsis
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- inflammation signs
- vital signs abnormalities - neuro syx - hematologic - anaerobmic metabolsim - electrolyte abnormalities - organ damage |
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clinical manifestations of sepsis
signs of inflammations |
–Redness, swelling, heat, pain
–Elevated erythrocyte sedimentation rate |
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clinical manifestations of
vital signs abnormalities |
-Hemodynamic instable
–Tachypnea |
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clincial manifiestations of sepsis
neuro syx |
–Decrease level of conscious (LOC)
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clincial manifiestations of sepsis
hematologic |
–Leukocytosis, leukopenia, thrombocytopenia
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clincial manifiestations of sepsis
anerobic metab |
–Serum lactate > 4mmol/L
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clincial manifiestations of sepsis
electrolyte abnormalities |
-acidosis
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clincial manifiestations of sepsis
organ damage |
–Renal
• Decrease urine output –Hepatic • Increase liver enzymes and decrease function –Respiratory • Acute respiratory distress syndrome (ARDS) –Gastrointestinal • Decrease perfusion |
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abx that covers psa
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-pipercillin
-ticarcillin - zosyn - aztreonam - timentin - carbapenem (except ertapenum) - ceftazidime - cefepime - cipro -amg - levo |
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normal urine output
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1 cc/kg/hr
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dx of sepsis
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• Patient history and physical exam
• Cultures (blood, sputum, urine, etc.) • CBC with differential • Chem 7 (BUN, SCr) • Lactate level • Coagulation tests • Liver function tests • Arterial blood gas |
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sepsis mgm look at
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- hemodynamic instability
- hemodynamic monitoring - surviving sepsis: abx, resusitation and supportive tx |
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hemodynamic equations
bp co svr map |
Blood Pressure= CO X SVR
co=cardiac index CO=HR X Stroke Volume Systemic Vascular Resistance (SVR) = 80 x (MAP- CVP) / CO Mean Arterial Pressure (MAP) = 1/3 systolic BP + 2/3 diastolic BP |
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3 things to inc heart rate
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- give prbc
- give inotropes to inc heart rate - give fluids |
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def of hemodynamic instablity
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dec in sbp >40
-sbp <90 - map <70 |
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hemodynamic monitoring looks at
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- cvp (central venous pressure)
- oxygen sat - pulmonary artery catheter ( swan ganz catheter) --> dx types of shock by looking at ci, svr, and pcwp |
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normal cvp is
in sepsis |
2-6 mmHG
want higher than this |
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how does this affect ci, svr, and pcwp
hypovolemic shock |
ci= dec
svr= inc pcwp= dec |
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how does this affect ci, svr, and pcwp
cardiogenic shock |
ci= dec
svr= inc pcwp= inc |
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how does this affect ci, svr, and pcwp
septic shock |
ci= inc
svr= dec pcwp= no change |
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def cardiac index
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the amt of blood the lv ejects into the systemic circulation in 1 min
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resuscitation goals should be achieved w/ in ?
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6 hrs
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what are the resuscitation goals
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1) Central venous pressure (CVP)
–8-12 mmHg –Higher target during ventilation or cardiomyopathy • 12-15 mmHg 2) Mean arterial pressure (MAP) –>65 mmHg 3) Urinary output (UOP) –>0.5 ml/kg/hr 4) Central venous oxygen saturation –>70% • Mixed venous >65% |
