Term
Systemic Inflammatory Response Syndrome
SIRS |
|
Definition
Temp >100.4 or <96.8
HR > 90
resp rate > 20 or PaCO2 <32
WBC > 12000 or < 4000 or >10% bands |
|
|
Term
|
Definition
| SIRS secondary to a suspected or proven infection |
|
|
Term
|
Definition
sepsis complicated by acute organ dysfunction, hypoperfusion or hypotension
altered mental status, hypoxia, ARDS, heart failure, etc. |
|
|
Term
|
Definition
severe sepsis with persisten hypotension despite adequate fluid resuscitation in the absence of other causes for hypotension
SBP < 90
MAP < 60
SBP > 40 from baseline |
|
|
Term
|
Definition
endotoxin (G-B) or peptidoglycan (G+B) activate macrophages which stimulate CD4 cells to release
cytokines |
|
|
Term
| first line therapy for sepsis treatment |
|
Definition
1. FLUID RESUSCITATION
1 L crystalloid over 30 mins
2. blood cultures
3. empiric antibiotic therapy |
|
|
Term
| initial resuscitation goals |
|
Definition
CVP 8-12 (12-15 if mechanical vent)
MAP > 65
urine output > 0.5 ml/kg/hr
ScVO2 > 70%
may have to give blood if Hct < 30% |
|
|
Term
| Double coverage empiric coverage IF: |
|
Definition
Psuedomonas is known cause or suspected
OR
patient is neutropenic
do not exceed 3-5 days of treatment
descalate when appropriate |
|
|
Term
|
Definition
norepinephrine
dopamine
no difference in mortality |
|
|
Term
| big risk factor with dopamine |
|
Definition
|
|
Term
| second line vasopressors after first line maxed out |
|
Definition
epinephrine
phenylephrine
vasopressin |
|
|
Term
glucose control recommendations
|
|
Definition
use IV insulin to control glucose after > 180 mg/dL
goal of < 150 mg/dL |
|
|
