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9 Cards in this Set
- Front
- Back
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What is important when treating hypovolemic shock? |
1. restore intravascular volume and oxygen carrying capacity. 2. administer blood products if HgB < 7 g/dL; if pts are actively bleeding administer blood products regardless of HgB 3. pts may require vasopressors if hypotension is not rapidly reversed w/ fluid recusitation. -efficacy of vasopressors is reduced in pts not given enough fluids -risks are also increased in pts who have not received adequate fluids. |
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What is important in the treatment of obstructive shock? |
1. fluids and vasopressors can be used to temporarily improve end organ perfusion 2. treatment of the actual obstruction is the only way to resolve obstructive shock |
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What are the criteria for sepsis? |
documented or suspected infection along with: temp >38.3C (101F) or <36C (96.8F) HR > 90 bpm RRR > 20 breaths per minute or Paco2 <32mmHg WBC >12 Altered mental status Hyperglycemia - BG > 120 mg/dL w/out diabetes Immature leukocytes - bands > 10% significant edema or positive fluid balance |
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What is the criteria for severe sepsis? |
severe sepsis is complicated by organ dysfunction or hypoperfusion Criteria: -SBP <90 mmHG -venous saturation (Svo2) <70% -Need for mechanical ventilation -Hypoxemia (Pao2/Fio2 < 300) -CI > 3.5 -Decreased capillary refill (press finger until turns white; time for color to return normally less than 2 secs) -mottling -mark with spots or smears of color -creatinine increase > 0.5 -coagulopathy -INR > 1.5 -Thrombocytopenia -plts < 100 -hyperbilirubinemia -total bili >4 mg/dL |
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How is septic shock defined? |
sepsis induced hypotension persistent hypotension or a requirement for vasopressors after the administration of IV fluids |
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When should abx be given during septic shock? |
ideally within the first hour of hypotension |
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What is SSC? What are SSC bundles? |
Surviving Sepsis Campaign SSC bundles are selected elements of care taken from evidence based practice guidelines that when implemented as a group have a greater effect on outcomes than any individual element. |
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What does the SSC bundle recommend for pts w/ sever sepsis or septic shock? Within 3 hrs? Within 6 hrs? Vasopressor of choice? |
Within 3 hours: a. measure lactate level b. obtain blood cultures prior to admin abx c. administer broad spec abx (w/in 1 hr preferred) d. Administer 30 mL/kg crystalloid for hypotension or lactate 4 mmol or more i. no evidence colloids are superior to crystaloids ii. hetastarch not recommended because of an increased risk of kidney damage iii. "balanced crystalloids" (LR) may lead to less kidney damage Within 6 hrs: a. apply vasopressors for hypotension that does not respond to fluids to maintain MAP 65 mmHg or greater i. increase goal as needed based on overall clinical picture (lactate level, mental status, urine output, capillary refill ii. if vasopressors initiated during fluid recusitation then try and wean off after IV fluids done iii. vasopressors improve tissue perfusion by increasing BP or CO iv. norepinephrine is vasopressor of choice v. epinephrine can be added to or substituted if needed vi. vasopresson is another alternative to epinephrine for additive therapy vii. dopamine can also be used, however, it is associated with higher incidences of arrhythmias compared to norepi. Low dose dopamine should be limited to those pts with low risk of tachyarrhythmias and absolute or relative brady cardia. Low-dose dopamine should not be used for renal protection. viii. phenylephrine is another alternative ***USE A CENTRAL LINE b. In the event of persistent arterial hypotension iCVP goals are 8-12; or 12-15 for pts on vent and central venous oxygen saturation (Sco2) should be 70%. ii. if can not get to goals despite fluid recusitation and MAP > 65 then consider additional fluids, packed RBCs, or dobutamine. iii. remeasure lactate levels it they were elevated; goal is to normalize them |
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Are corticosteroids recommended in pts w/ septic shock? |
Corticosteroids are not recommended in pts with septic shock if they have been stabilized by fluids and vasopressor therapy. If they are not stabilized, however, the SSC suggests IV hydrocortisone alone at a dose of 200 mg/day. SSC recommends against using the corticotropin stimulatrion test. |
