SEPTIC SHOCK

SEPTIC SHOCK

1. ASSESSMENT

   • LAB TESTS
     • PROCALCITONIN: ELEVATED LEVELS
     • GRAM STAINS AND CULTURES TO IDENTIFY BCTERIA
       • URINALYSIS AND URINE CULTURE TO R/O UTI
       • BLOOD CULTURE TO DETECT SUSCEPTIBILITY TO ANTIBIOTICS
       • SPUTUM CULTURE TO DIAGNOSIS BACTERIAL PNEUMONIA
     • CBC: EVALUATE RBC, WBC, AND PLATELETS
   • DIAGNOSTIC TESTS
     • ECG: decreased QRS amplitudes
     • X-RAY
       • GOOD TO VISUALIZE ABNORMALITIES IN LUNGS
     • CT
       • GOOD TO VISUALIZE ABNORMALITIES APPENDIX, PANCREAS, BOWEL
     • MRI
       • USEFUL TO IDENTIFY SOFT TISSUE INFECTIONS SUCH AS ABSCESSES IN SPINE AND BRAIN
     • ULTRASOUND
       • USEFUL TO FIND INFECTION IN GALL BLADDER OR OVARIES
   • ASSES VITAL SIGNS
   • HEMODYNAMIC MONITORING
   • HEAD TO TOE
     • AIRWAY
       • IS AIRWAY PATENT?
       • SWELLING PRESENT?
       • ABILITY TO TALK
     • BREATHING
       • NOTE RATE, DEPTH, RHYTHM, QUALITY
       • O2 SATURATION
       • ACCESORY MUSCLE USE
     • CIRCULATION
       • PULSE
         • RATE, RHYTHM, QUALITY
       • BLOOD PRESSURE
       • CAP REFILL < 3 sec
       • TEMPERATURE
     • DISABILITY
       • GLASGOW COMA SCALE
       • AVPU
         • ALERT
         • RESPONDS TO VERBAL/PAINFUL STIMULI
         • UNRESPONSIVENESS

2. TREATMENT & NURSING INTERVENTIONS

   • VENOUS ACCESS
     • FLUID REPLACEMENT
       • IF THEY DON'T RESPOND TO FLUID REPLACEMENT....
         • CENTRAL VENOUS CATHETER SHOULD BE PLACED
           • ALLOWS MEASUREMENT OF CENTRAL VENOUS PRESSURE TO ASESS VOLUME STATUS
             • AIMING FOR > 8 mmHg
         • ADMINISTER FLUIDS, ANTIBIOTICS, VASOPRESSURES
           • MAINTAIN ARTERIAL PRESSURE > 65 mmHg
       • CRYSTOLLOID FLUID BOLUS OF 30 mL/Kg over 30-60 mins
     • ANTIBIOTIC THERAPY
       • INITIALLY DO BROAD SPECTRUM TO COVER GRAM +/- ANAEROBIC BACTERIA
       • CONSIDER PATHOGENS OF ANTIBIOTIC RESISTANCE
         • MRSA
         • PSEUDOMONAS SPECIES
         • GRAM - ORGANISMS WITH ESBL ACTIVITY
   • INSERT INDWELLING URINARY CATHETER
     • MONITOR RENAL PERFUSION AND ASSESS URINE OUTPUT. NORMAL URINE OUTPUT 30-50 cc/hr
   • INTUBATION AND MECHANICAL VENTILATION
     • DUE TO RESPIRATORY DISTRESS
     • AVOID NON-REBREATHER - DELIVER O2 DIRECTLY INTO TRACHEA
     • WITH SEDATION
       • TO ELIMINATE THE WORK OF BREATHING
       • DECREASES METABOLIC DEMANDS OF BREATHING
     • TO PREVENT ARDS - DO TIDAL VOLUME OF 6mL/Kg WITH PLATEAU PRESSURES kept at or < 30mL of water
       • PEEP IS REQUIRED TO PREVENT ALVEOLAR COLLAPSE AT END EXPIRATION
   • IF Hgb < 7g/dL A BLOOD TRANSFUSION IS RECOMMENDED TO PUT IT BETWEEN 7-9 g/dL
     • SHOULD GET PLATELET TRANSFUSION IF PLATELET COUNT IS < 10^9 /L FOR SEVERE SPESIS
   • TEMPERATURE CONTROL
     • ANTIPYRETICS
     • EXTERNAL COOLING I.E. COOLING BLANKETS OR SPONGING
       • DECREASES VASOPRESSURE REQUIREMENTS
         • SUCH AS.. VASOPRESSIN OR NOREPINEPHRINE
   • NTRITIONAL AND METABOLIC SUPPORT
     • K,MG, P LEVELS SHOULD BE CORRECTED IF ALTERED
     • MAY HAVE HIGH PROTEIN AND ENERGY REQUIREMENTS
     • GASTROPARESIS IS TREATED BY
       • MOTILITY AGENTS
       • PLACING A SMALL BOWEL FEEDING TUBE
     • ENTEREAL OR ORAL ROUTE PREFERRED FOR EARLY NUTRITIONAL SUPPORT
       • TO PROTECT THE GUT MUCOSA
       • TO PREVENT TRANSLOATION OF ORGANISMS FROM GI TRACT
   • MAY INCLUDE LOW DOSES OF CORTICOSTEROIDS TO SUPPRESS INFLAMMATORY RESPONSE
     • HYDROCORTISONE
   • MAY INCLUDE SHORT ACTING INSULIN TO MAINTAIN BLOOD SUGAR LEVELS
     • HYPERGLYCEMIA IMPAIRS IMMUNE SYSTEM

3. COMPLICATIONS

   • TINY BLOOD CLOTS REDUCE PERFUSION TO ORGANS
     • USE CLOTTING FACTORS IN THE BLOOD, AND EXCESSIVE BLEEDING OCCURS
   • ORGAN FAILURE
     • HEART
     • KIDNEY
       • EXCRETE LITTLE TO NO URINE AND METABOLIC WASTE I.E. UREA NITROGEN ACCUMULATE IN BLOOD
     • LUNGS
       • PLEURAL EFFUSION
     • LIVER
   • STROKE
   • LOSS OF PORTION OF BOWEL OR EXTREMITIES
   • EDEMA
     • BLOOD VESSELS BECOME LEAKY ALLOWING BLOOD TO ESCAPE FROM BLOODSTREAM INTO SURROUNDING TISSUE
   • DISSEMINATED INTRAVASCULAR COAGULATION (DIC)
     • SYSTEMIC BLOOD COAGULATION TO TRY AND COUNTERACT LEAKING BLOOD VESSELS
       • BODY CANNOT MAKE ENOUGH CLOTTING FACTORS TO KEEP UP AND CUASES INCREASED RISK OF BLEEDING
   • ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)
     • FLUID BIULD UP IN ALVEOLI = DECREASED OXYGENATION IN BLOOD
     • MANIFESTATIONS
       • SOB
       • HYPOTENSION
       • LABOURED TACHYCARDIA

4. ETIOLOGY AND RISK FACTORS

   • OLDER ADULTS
   • INFLAMMATION FROM INFECTIONS
     • BACTERIAL
     • VIRAL
     • FUNGAL
   • PEOPLE WITH WEAKENED IMMUNE FUNCTION
   • NEWBORNS
   • PREGNANT WOMEN
   • RHEUMATIC DISEASES
   • PEOPLE WITH PSORIASIS
   • CANCER PATIENTS

5. DESCRIPTION

   • Infection causing sepsis. Occuring when chemicals that fight infection are released into bloodstream causing inflammation
   • 3 STAGES
     • 1. SEPSIS : INFECTION IN BLOOD STREAM CAUSING INFLAMMATION
     • 2. SEVERE SEPSIS: SEVERE INFECTION CAUSING ORGAN IMPAIRMENT
     • 3. SEPTIC SHOCK: SIGNIFICANT DROP IN BP EADING OR ORGAN FAILURE

6. SYMPTOMS

   • FEVER
   • HYPOTHERMIA
   • TACHYCARDIA
   • HYPOTENSION
   • TACHYPNEA
   • OLIGURIA
   • CONFUSION
   • DIZZINESS
   • RESPIRTATORY DISTRESS
   • CYANOSIS

Images and files in the map