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)