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IOS 10 Exam 4
Sepsis
| Question | Answer |
|---|---|
| Systemic Inflammatory Response Syndrome is | > 2 of the following criteria: |
| Sepsis- is defined as | SIRS + Infection |
| Severe Sepsisis is defined as | Sepsis with organ dysfunction, hypo-perfusion or hypotension |
| Septic Shock-is defined as | SBp<90 mmHg or drop of 40 |
| (SIRS) Systemic Inflammatory Response Syndrome MOA | Causes Cytokines release which activates NO, PDG1, and prostacyclin, Down regulate alpha and beta receptors 3. Relative decrease in vasopressin (ADH lack of constriction) and cortisol |
| (CARS) compensatory anti-inflammatory response syndrome MOA | (IL-1ra), IL-4, and IL-10. |
| Cardiogenic Shock-Cold shock | PUMP IS NOT WORKING Builds up =PCWP (alpha and beta mediated) refractory hypotension or heart failure symptoms, uncertain volume status, or declining renal function. Problem is decrease Cardiac Output the body will increase SVR . The body vaso-constricts |
| Distributive Shock is | Warm shock, Decrease in SVR (vasodialation more volume for blood to distribute- mediated by NO) , will lead to increase in CO-response tachycardia. |
| Hypovolemic Shock | Cold shock Decrease in Volume (Trauma-bleeding), and a decrease in pulmonary capillary wedge pressure (left ventricle blood flow) and body trys to compensate by increasing SVR (constriction). S/S Vomiting Blood-Obvious |
| Goals of therapy | 1.Arterial pressure (MAP ≥ 65 mmHg with CVP 8-12 mmHg), 2. Urine production (≥ 0.5 mL/kg/hr),3. Skin perfusion, mental status, and indexes of perfusion (↓ lactate, SVO2 ≥ 70%).We do this by increasing preload (PCWP) with fluid replacement |
| Shock causes | Build up of Lactic acid- (anion gap) Metabolic acidosis |
| Therapy of sepsis | 1.Crystalloid (NS, lactated ringers) or colloid (albumin, hetastarch) if edema 2.Vasopressor - Norepinephrine- Direct A 1 and B 1 or Dobutamine IF (CO,2.5L/min or SVO2<70%) 3. Corticosteroida.IF 1.Cortisol response test 2. Pressor >48hr |
| Corticosteroid effect is sepsis | Directly and indirectly inhibit NF-kB to reduce inflammation (SIRS), reduce NO, and increase alpha and beta receptors. (200 to 300 mg/day) of hydrocortisone |
| Norepinephrine-MOA | Direct Alpha 1 and Beta 1- Causing more vasoconstriction increase CO. Increase work load on heart (dangerous-MI) |
| Phenylephrine-MOA | alpha 1 only Great if tachycardic |
| Vasopressin-MOA | V1 to enhance fluid retention and increase urine output (increase in mortality) B1 tachycardia |
| Dobutamine-MOA | More B2=more vasodilatation and decreased SVR Use IF (CO,2.5L/min or SVO2<70%) |
| Dopamine-MOA | Converted and release endogenous CCA’s- body has already released) Dose response: <5mcg -Dopamine (vasodilatation = increase urine production), 5-10mcg Beta1(increase CO) –> 10mcg alpha-Contract |
| Drotrecogin-alfa- | Recombinant human activated protein C, which has both anti-inflammatory and anticoagulant propertiesIndication: Use within 48 hours of severe sepsisContraindicated: Trauma patients and Surgery patients due to increase bleed risk |
Created by:
liza001
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