SHOCK/SEPSIS

Shock States

100

Decreased venous return, decreased stroke volume, decreased CO, decreased tissue perfusion. Usually exhibits few, if any, clinical signs and symptoms (reversible)

Bonus: What will you see?

What is initial stage? 

What is Tachypnea (altered tissue perfusion)

200

• Increased HR/contractility, vasoconstriction, blood shunted to vital organs, catecholamine release, Renin angiotensin Aldosterone System response activated (Na/water retention)

Bonus Point: What will you see?

What is the compensatory stage?

What is Restless, agitated, confused, normal BP/hypotension, tachycardia, tachypnea, decreased UO, hypoactive BS, increase glucose, Na, lactate, decrease paO2/pCO2, increase pH (alkalotic – blowing off CO2)

300

• Compensatory mechanism begins to fail

• Ineffective tissue perfusion leading to organ dysfunction (failure of GI/renal, followed by cardiac, liver, then cerebral function)
  
  Bonus: What will you see?
  
  

What is progressive Stage? 

What is Hypotensive, tachycardia, weak pulse, mottled/cold skin, tachypnea, shallow breathing, oliguria, absent BS, increased lactate, decreased pO2, decreased bicarb, increased CO2 (acidotic)

400

End-organ failure (irreversible) 

What will you see?

What is Increased cellular death, profound organ failure, patient death

500

Temperature - Less than 96.8F or greater than 100.4 Tachycardia - Heart rate greater than 90 bpm Tachypnea - Respirations greater than 20 per min or PACO2- Less than 32 mmHg WBC- Less than 4,000 or greater than 12.000 or greater than 10% bands 2 OR MORE DON'T IGNORE

What is SIRS Criteria

General Shock Questions :

100

Hypotension Altered mental status Tachycardia decreased CVP Prolonged capillary refill Dry muscus membranes Poor Skin Turgor Concentrated Urine/Oliguria

What is clinical Presentation of Hypovolemia

200

Rapid fluid device available in the ICU, Surgery, and ICU Warms fluid and blood Can infuse up to 950ml/minute

What is Rapid infuser?

300

Loss of forward movement of blood systolic dysfunction: heart failure, value disorders diastolic dysfunction: Heart failure, value disorders decreased ventricular wall motion = AMI decreased stroke volume decreased cardiac output pulmonary congestion hypoxemia

What is Cardiogenic Shock

400

Equipment Device that can be placed in the Cath Lab, Surgery, or ICU to improve cardiac ouptut and contractility Height of patient is important when inserting Need to assess and monitor tissue perfusion distal to insertion site

What is Intra-aortic Ballon Pump

500

Dobutamine Dopamine Levophed Neosynephrine Vasopressin Nitroglycerin Nitroprusside (Nipride)

What are the medications used to treat Shock?

Clinical Presentation

100

hypotension bradycardia temperature regulation hypothermia flaccid paralysis below level of injury bowel and bladder dysfunction decreased CVP, PWCP (preload = volume) decreased SVR ( afterload = reistance)

What is Neurogenic Shock

200

Massive vasodilation leading to an increase in size of the vascular compartment in proportion to the fluid volume. Neurogenic Anaphylactic Septic Massive vasodilation leading to an increase in size of the vascular compartment in proportion to the fluid volume.

What is Distributive Shock?

300

systemic release of mediators hypersensitivity reaction masssive vasodilation Anxiety Edema Increased respiratory rate

What is Anaphylactic Shock

400

Massive Pulmonary embolism Cardiac Tamponade Muffled heart sounds Pulsus paradoxus

What is Obstructive Shock

500

Progressive dysfunction of two or more organ systems as a result of an uncontrolled inflammatory response to severe illness or injury. Most common in Sepsis or Septic Shock

What is MODS (Multiple Organ Dysfunction Syndrome)?

General Sepsis Questions

100

This partnered with the Institute for healthcare Improvement (IHI) to incorporate its "bundle concept" into the diagnosis and treatment of patient's with sepsis, severe sepsis and septic shock.

What is "The Surviving Sepsis Campaign"?

200

advanced age compromised immune function chronic illness invasive interventions malnutrition surgical procedures sequential infections

What is "Who is at risk for Sepsis"?

300

Elevate HOB at least 30 degrees Daily sedation vacations Peptic Ulcer Prophylaxis Deep Vein Thrombosis Prophylaxis

What is Ventilator Associated Pneumonia (VAP )Bundle

400

avoid unnecessary catheterization asesptic technique hand hygiene chlorthexidine skin antisepis reduction of MRSA

What are some Prevention Strategies for Sepsis?

500

quality partnership committed to improving the safety of surgical care Prophylactic antibotics with obne hour Prophylactic antibotics discontinued within 24 hours and 48 for Cardiac surgery

What is Surgical Care Improvement Project (SCIP)?

Sepsis cont:

100

Development of SIRS in the presence or presumed presence of infection usually have at least two of the following: chills hypotension decreased skin perfusion impaired capillary refill or mottling decreased urinary output significant edema or positive fluid balance hyperglycemia >120

What is Sepsis?

200

Inadequate organ perfusion Dysfunction of two or more organ systems

What is Severe Sepsis?

300

cough, change in sputum Nausea/vomiting or diarrhea. abdominal pain Dysuria, frequency New murmur/change in murmur Headache, change in LOC drainage changes in wound

What are some clinical assessment signs and symptoms of sepsis?

400

Develops in response to severe sepsis Extensive increased capillary permeabilty

What is MODS?

500

Occurs in 1% of all hospitalized patients Trigger- excessive activation of coagulation cascade Trauma

What is DIC?