SIRS – systemic inflammatory response syndrome
Temp >100.4 or < 96.8
Heart rate > 90
Respiratory rate > 20
WBC > 12k or < 4k

Two or more SIRS criteria and a source for infection = sepsis
Sepsis + lactate > 4 or systolic blood pressure < 90 = severe sepsis
Severe sepsis where hypotension persists after fluid resuscitation = septic shock.

Shock is hypoperfusion, hypoperfusion leads to anaerobic metabolism, which leads to increased lactate.

Systemic inflammation leads to increased capillary permeability = leaky capillary beds = 2nd and 3rd spacing of fluid

Levophed (norepi) is first line pressor for septic shock.

CVP = garbage but measure it if your protocol demands it, 8-10 in spontaneously breathing patients, 10-15 in ventilated patients

SVO2 – mixed venous oxygen saturation = > 70%, < 70% means poor oxygen carrying capacity – consider PRBCs or inotropic medications.

a1 receptors – a for artery! – a1 agonists cause smooth muscle contraction (vasoconstriction)
b1 receptors – 1 for 1 heart! – b1 agonists increase cardiac contractility (beta blockers, aka b1 antagonists,  do the opposite)
b2 receptors – 2 for 2 lungs! – b2 agonists decrease bronchospasm and increase bronchodilation (albuterol)

2 Responses to Show Notes for Episode 05 – Sepsis

  • NYRN says:

    I love your podcasts, they are really informative! Thank you for taking the time to put these together. If I might offer a piece of feedback, the background music playing during your podcast is incredibly distracting. If you asked for my opinion, I would prefer to just hear your speak without any background music. Thanks again!

    • rick sharf says:

      I agree with the feedback. I’m just starting my ICU rotation and really enjoy hearing your points of view. Any way I can download them without the music?

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