Summary: Physiology Advanced Concepts

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• 1 Sepsis

• 1.1 College 1

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• What is a septic shock?

  Uncontrolled response of the body to severe infection (sepsis), together with the need for medications to normalize blood pressure and normalize other values.

• Where does sepsis start?

  Can start in every organ, depends where infection starts

• Which receptors are pretty important for the development of sepsis?

  Toll like receptors

• How does the pathway via the TLR leads to sepsis?

  TLR activate production of cytokines -> recruit immune cells to the site of infection (which is a good thing, but when the response is too much a sepsis develops). Normally the reaction of the body is locally, but in the case of sepsis there is an uncontrolled amplification of the immune response throughout the whole body

• How is the severity of sepsis determined?

  By the SOFA score (3 categories, for each you can give 1 point when the patients meets the requirement). If the score is 2 or higher then the patient has a severe sepsis (admitted to ICU)
  

• What happens during a septic shock?

  There is decreased oxygen delivery to the tissues and this may lead to hypotension and eventually to organs that are not able to perform their normal function (organ failure).

• What is important when a patient is very sick?

  Administer broad-spectrum antibiotics within the hour. For patients that are less sick, you can wait till you have cultured samples to be more specific.

• Which drugs are often used to treat sepsis?

  1. Norepineprhine
  2. Vasopressin (ADH) (used in combination with 1)
  3. Dobutamine
  4. Mihinone
  5. Phenylephrine

• How does norepinephrine work?

  1. Norepineprhine
  --> increases BP and SVR (alpha 1 receptors on blood vessels)
  --> protects blood flow to organs (beta 2 receptors on bv) 
  --> increases HR and CO (beta 1 receptors on heart)
  
  This improves the delivery of oxygen

• How does vasopressin (ADH) works?

  2. Vasopressin (ADH) (used in combination with 1)
  --> increases SVR and BP; increases volume (V1 receptors on bv)
  --> increases H20O reabsorption and therefore increase of BP (V2 receptors kidney)
  
  --> may lead to ischemic toes and fingers because tightening of blood vessels is too much