Surviving sepsis
What is the definition of sepsis?
Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection
Which metabolite is often low in septic patients, resulting in a metabolic shock? How would you treat this on an emergency basis?
Blood glucose
Bolus 0.5g/kg IV and supplement ongoing fluids
How does GDV cause cardiovascular instability?
Hypovolaemia - bleeding, sequestration of fluid
Obstructive - decreased VR
Distributive - systemic inflammation
Acid base disturbances?
What cardiac condition that results in cardiogenic shock via pump failure? Name 1 drug that may be used to treat this on an emergency basis.
DCM or myocardial depression of sepsis. Dobutamine/pimobendan
Define shock. What is the most common cause of shock in small animal patients?
Inadequate cellular energy production. Hypoperfusion (decreased circulating volume)
What are the 2 most time critical treatments of sepsis (after initial patient stabilisation)?
Early antibiotic therapy (1 hour)
Source control (6 hours)
List 5 organ systems that may be impaired in a septic patient AND the laboratory test you would run to diagnose each
AKI (creat), hepatic (TBil), coag (Plt, coag testing), CV (lactate/BP), resp (ABG)
List 3 clinical exam features of pericardial effusion with cardiac tamponade. The US machine is out of use for this question.
Pulsus paradoxus
Muffled heart sounds
Electrical alternans
Clinical evidence of hypoperfusion
Jugular pulsation/distension, hepatojugular reflex
What condition can cause sudden collapse and cardiovascular instability, and may occur in a biphasic manner?
Anaphylaxis
List 3 causes of a type B hyperlactataemia
Type B hyperlactatemia: occurs without clear evidence of hypoperfusion or tissue hypoxia.
Type B1: underlying disease - sepsis, diabetes mellitus, liver disease, and certain types of neoplasia Type B2: drug or toxin-induced - glucocorticoids, beta 2-agonists, and catecholamines. Toxins such as ethylene glycol or propylene glycol also interfere with lactate metabolism, leading to elevated levels.
Type B3: inborn errors of metabolism
The vasopressor agent of choice when treating vasodilatory shock?
Norepinephrine
What is a degenerative left shift? Would you like one if you were septic?
When the absolute numbers of band or immature neutrophils are greater than the absolute numbers of mature or segmented neutrophils.
Absolutely not - it is associated with a higher morbidity and mortality
What condition may be considered in a dog with a travel history to Southern USA, presenting with shock and pigmenturia?
Heartworm - caval syndrome
Name a cardiac complication that may arise from vomiting in a shocky patient. What emergency drug therapy might you consider using?
Vagally mediated bradycardia. Atropine or CPR if needed!
Provide 5 different mechanisms of hypoxia
Hypoventilation
Low inspired O2
Low VQ
Diffusion impairment
Shunting
What is a potential treatment for a patient with refractory hypotension despite adequate volume loading and norepinephrine and dobutamine therapy?
Hydrocortisone (CIRCI). Would also accept vasopressin if someone is feeling wealthy.
Are bacteria always seen in septic effusions? Provide a supportive argument for your answer.
No. Upper GI (gastric) perforations, previous antibiotic therapy, walled off infection or intermittent leakage
List 10 possible sources of sepsis in the dog or cat
Pyometra, prostatic abscess, pneumonia, pyelonephritis, septic peritonitis, pyothorax, necrotising fasciitis, endocarditis, discospondylitis, fungal infection, bacterial translocation, mastitis, hepatic abscess, deep pyoderma, septic joints, CNS sepsis etc
A patient recovering from a pericardectomy develops tachycardia and respiratory distress in the post-op period. List 3 possible causes.
Bleeding/hypovolaemic shock
Pain
Pneumothorax/hypoxic shock
PTE - hypoxic shock/obstructive
What substance, often associated with smoke inhalation, can cause tissue hypoxia? How is this treated on an emergency basis?
Carbon monoxide. O2 therapy ASAP
If a dog with a history of intestinal surgery presents to the hospital with anything other than a routine recovery, what is the diagnosis until proven otherwise?
Septic peritonitis
What electrolyte, when low, may cause hypotension in septic patients?
Bonus point for picking a tricky category!
:)
You are feeling brave! Fancy a cardiology residency? Have a bonus point instead.
Bonus point :)
Draw the determinants of oxygen delivery (DO2)
DO2 = CO x CaO2 etc.