Resp 180 Exam 3: Septic Shock

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Author:
kjeidsness
ID:
183483
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Resp 180 Exam 3: Septic Shock
Updated:
2012-11-13 18:05:34
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Respiratory disease resp180
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Description:
When bacteremia causes changes in circulation so tissue perfusion is critically reduced. Usually caused by gram negative organism, staphylococci, or meningococci.
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  1. Definition of Septic Shock
    When bacteremia causes changes in circulation so tissue perfusion is critically reduced. Usually caused by gram negative organisms, staphylococci, or meningococci.
  2. What is Septic Shock Characterized By?
    • Acute circulatory failure
    • followed by hypotension & multi-organ failure
    • skin warm
    • urine reduced
    • pt confused & less alert
    • lung, kidneys, & liver failure
  3. Etiology (cause) of Septic Shock
    • *Nosocomial infection with gram negative bacilli
    • *In 1/3 by gram positive cocci & candida organisms

  4. Who does Septic Shock OCCUR in?
    • Immunocompromised pts.
    • Pts. with chronic disease
    • Newborns
    • Patients under 35
    • Pregnant women
  5. Risk Factors for Septic Shock
    • Diabetes
    • Cirrhosis: lead to liver cancer, hits kidneys & liver
    • Leukocytopenia: decreased white blood cells-can't fight 
    • Infection in urinary, biliary or GI tracts
    • Invasive devices: catheters & drains
    • Ventilators
  6. Pathogenesis of Septic Shock
    • Release toxins
    • Vasodilation of arteries and arterioles occurs--> Decrease systemic vascular resistnace
    • Later decrease C.O. ---> higher peripheral resistance
    • Blood flow impaired: O2 and CO2 transport affected
  7. Signs & Symptoms of Septic Shock
    • Altered mental: earlies sign
    • Hypotension: blood pressure drop
    • Warm skin
    • Tachycardia
    • Tachypnea
    • Oligurea: urine production output drops off
    • Cool, pale extremities with peripheral cyanosis and mottling: blue arms & legs
    • Multi-organ fail: kidneys, lungs, liver & heart- late sign
  8. Diagnosis of Septic Shock
    • Hypovolemic shock responds to volume repletion
    • Cardiogenic shock associated with MI
    • Obstructive shock: complication of PA obstruction from embolization
  9. What's the C.O. of Septic Shock? 
    NL or increased with decreased systemic vascular resistance and warm dry skin
  10. What's the C.O. of a LATE sign of septic shock?
    Decresed C.O. with increased pulmonary vascular resistance
  11. What Helps Diagnose Septic Shock?
    Pulmonary Artery Catheter: to exclude nonseptic causes of shock
  12. ABGs of Septic Shock
    • Early: Respiratory alkalosis
    • Progressive: Metabolic acidosis
    • Early respiratory failure leads to hypoxemia
  13. Mortality with septic shock is:
    • 25-90% 
    • If adequate treatment not started, higher mortality.
    • Once severe lactic acidosis occurs with multi-organ fail: septic shock irreversible
  14. Treatment with Septic Shock
    • In ICU: monitor BP, arterial & venous pH, ABGs, blood lactate levels, renal function, and electrolytes
    • Support with ventilation with nasal O2, intubatation or tracheostomy, and ventilator as needed.
    • Antibiotics after culture & early
    • DON'T GIVE VASOPRESSORS: high risk for vasoconstriction
  15. What Should be Measured with Septic Shock?
    • Measure: central venous pressure or pulmonary artery pressure.
    • Give fluid replacement until CVP reaches 10-12 cm H2O or till the PCWP reaches 12-15 mm Hg
  16. The Septic Shock Patient is Still Hypotensive After Volume Has Raised the PCWP to 15-18?
    Give dopamine to increase BP to less than or equal to 60
  17. What Do You Give For Diuresis of Septic Shock Pts.?
    Mannitol or furosemide
  18. What do you give for Pts. in Heart Failure or in DIC with Septeci Shock?
    Digitalis or Heparin

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