Term
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Definition
| Systemic Inflammatory Response Syndrome. It's an overwhelming inflammatory response. |
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Term
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Definition
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Term
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Definition
| Sepsis + 1 or more organ failures |
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Term
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Definition
| Sepsis that presents with hyptotension that persists despite adequate fluid resuscitation that requires inotropic and/or vasopressor support |
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Term
| What is the definition of hypotension? |
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Definition
| systolic BP <90 mmHg OR a reduction greater than 40 mmHG from baseline in the absence of other causes for hypotension |
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Term
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Definition
| Multiple organ dysfunction syndrome. Alteed organ function requiring intervention to maintain homeostasis |
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Term
| What are the three most common infection sites that lead to sepsis? |
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Definition
Respiratory tract
Intra-abdominal
Urinary Tract |
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Term
| What are the most common causes of sepsis? |
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Definition
Gram positive (40-50%)
(staph and strep)
Gram negative (38%)
Fungi (17%) |
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Term
| What are the four most common Gram Positive agents in sepsis? |
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Definition
Staph Aureus
Strep pnemonea
Coagulase-negative Staph
Enterococus |
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Term
| What are the six most common gram negative agents in sepsis? |
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Definition
E coli
Pseudomonas aeruginosa
Klebsiella
Serratia
Enterobacter
Proteus |
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Term
| What are the most common Fungi in sepsis? |
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Definition
Candida Albacans
Candida Glabrata
Candida paapsiloiss
Candida Tropicalis
Candida krusei
Aspergillus |
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Term
| What are the risk factors for fungal sepsis? (8) |
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Definition
Catherters
Prolonged granulocytopenia
TPN
Abdominal Surgery
Broad spectrum abx
Corticosteroids
Heme malignancy
Diabetes |
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Term
| What are the goals for treatment? (4) |
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Definition
CVP 8-12 mmHg (12-15 if on vent)
MAP >= 65 mmHg
Urine output >= .5mL/kg/hr
Central venous oxygen sat >= 70 or mixed venous >=65% |
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Term
| What is the target hct in the first six hours and why? |
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Definition
| 30%. You want as much oxygen carrying capacity as possible. Then drop to 7-9 g/dl after six hours. |
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Term
| When do you give platelets? |
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Definition
if less than 5000, give then.
5000-30,000 if risk of bleeding
less than 50,000 if having surgery |
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Term
| What are the first, second, and third lines for vasopressors? |
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Definition
1st: Norepinephrine or dopamine
2nd: Epinephrine if NE or dopa don't work
3rd: Phenylephrine or vasopressin added to 2nd line |
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Term
| What types of agonist is NorEpi? |
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Definition
a1 and B1
NO dopaminergic activity |
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Term
| What type of agonist is dopamine? |
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Definition
Dose dependant:
0.5-3 mcg/kg/min = dopaminergic
3-10 = B1
10-20 = alpha |
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Term
| What types of agonist is Epinephrine? |
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Definition
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Term
| What type of agonist is phenylephrine? |
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Definition
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Term
| What type of agonist is vasopressin? |
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Definition
| It's a direct vasoconstricture mediated by vascular V1. |
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Term
| What types of agonist is Dobutamine? |
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Definition
B1 agonist
Weak B2 and alpha 1. Can be used in combo with vasporessor therapy. |
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Term
| How fast must antibiotics be started? |
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Definition
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Term
| When (if ever) do you use corticosteroids? |
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Definition
| They are recommended in patients with septic shock who despite adequate fluid replacemement require vasopressor therapy to maintain blood pressure. |
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Term
| What steroids do you use? |
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Definition
Hydrocortisone for 7 days
with or without fludrocortisone |
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Term
In sepsis, what happens to
HR, BP, CO, Preload, and Afterload? |
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Definition
HR goes up
BP goes down
CO goes Up (then falls)
Preload (up or down)
Afterload (down) |
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