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19 Cards in this Set
- Front
- Back
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What is SIRS? |
Systemic inflammatory response syndrome |
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What is SIRS defined as? |
Two or more of the following:
TEMP >38 or <36
HR >90bpm
Resp rate >20 or PaCO2 <4.3kPa
WCC >12 or <4 |
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Sepsis is defined as what? |
These symptoms listed in SIRS + clinical evidence of an infection
Sepsis = Infection + SIRS |
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What is severe sepsis? |
Sepsis (which is SIRS + infection) + Organ hypoperfusion and/or organ dysfunction and/or hypotension |
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Septic shock is what? |
All of the above + Hypotension which is refractory to infection |
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Mortality of septic shock and severe shock? |
Shock = 46%
Severe sepsis = 20% |
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Name three lipid mediators of inflammation? |
Prostaglandins Leukotrienes Platelet activating factor |
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Name three pro-inflammatory cytokines? |
TNF-alpha IL-1 IL-6 |
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When complement is activated what action does it take? |
Opsonisation of bacteria
Lysis of pathogens
Recruitment of inflammatory cells |
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Describe three vascular changes that occur as a result of the inflammatory response? |
PAF - Increases platelet aggregation and adhesion
TNF-a and C5a - Increased vascular permeability
Nitric oxide - Loss of contractility of vascular smooth muscle |
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TNF alpha and IL-1 cause release of what which leads to which process? |
Thromboplastin
Activates the coagulation cascade and then DIC causing microcirculation occlusion and end organ failure |
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Name five risk factors for severe sepsis? |
Immunosupression Comorbidity Age Invasive devices i.e. pacemakers or pins Antimicrobial use |
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Aside from the four markers of sepsis of which you need two, name two other sepsis indicators? |
CRP increase Decreased platelets
(in the future procalcitonin will be used) |
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Two early and two late signs of organ hypoperfusion? |
Early: Resp alkalosis and Oliguria
Late: Increased lactate and delayed cap refill |
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Name the four principles of treatment for severe sepsis? |
Resuscitation
Antibiotics
Treat focus of infection
Monitor and minimise organ damage |
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Resus principles of treatment involve what in severe sepsis? |
Fluids
Oxygen and (ventilation if necessary)
Vasopressors in high cardiac output phase
Inotropes in cardiac depression stage |
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ABC given via which route in severe sepsis? |
IV |
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In terms of monitoring organ damage in severe sepsis what must be looked for? |
Optimise blood oxygenation and circulation
LOOK FOR DIC: heparin and replace clotting factors and platelets
Correct severe acidosis |
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What are the sepsis six? |
100% oxygen 15l free flow
IV fluid bolus 500-1000ml bolus of hartmann's
Blood cultures
IV ABx
Lactate+bloods (FBC,U+E,LFT,Clotting)
Monitor urine output hourly |
