ANSWER TO QUIZ OF THE WEEK: MARCH 25, 2005

1. He has Shock Septic.

This patient has 3 or more signs of Systemic Inflammatory Response Syndrome (SIRS) including tachycardia, increased RR (as seen by increased minute volume), fever, increased white count.

His SIRS is likely due to infection (gm positive cocci in blood), therefore he has Sepsis Syndrome.

Along the severity of the disease continuum, he has Sepsis with evidence of organ failure (respiratory, neurological, cardiovascular). Organ failure CAUSED by Sepsis defines either Severe Sepsis or Septic Shock. Severe Sepsis is present when the hypotension responds to fluid resuscitation. When hypotension persists in the presence of adequate intravascular volume, the condition is referred to as Septic Shock.

2. Organ Failure caused by Severe Sepsis or Septic Shock is an indication for drotrecogin alfa activated (Xigris), or Activated Protein C. It is recommended within 48 hours of the onset of organ dysfunction. Activated Protein C is an endogenous substance that decreases inflammation, produces anticoagulation and profibrinolysis (clot buster). Endogenous activated protein C is decreased in Septic Shock.

Prior to administration, contraindications including risk for serious bleeding (espeically neurolgoical or gastrointestinal tract) must be ruled-out.

 

See the following links:

Inflammation

Sepsis

References:

Bernard, G. et al. (2001). Efficacy and safety of recombinant human activated protein C for severe sepsis. NEJM, 344, 699-709.

Vincent, J. et al. (2003). Effects of drotrecogin alfa (activated) on organ dysfunction in the PROWESS trial*. Crit Care Med. 31(3); 834-840.

 

Brenda Morgan
Clinical Nurse Specialist, CCTC
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