Segments in this Video

Beyond The Basics (00:27)


Robin Gilbert provides a brief overview of the lecture.

Hemodynamics (01:54)

Hemodynamics refers to the inner relationship of blood pressure, blood flow, vascular volume, ventricular function, and the physical properties of blood. Cardiac output is the volume of blood ejected during ventricular contractions and is used to assess perfusion status, response to therapies, and hemodynamic status.

Definition Review (06:46)

Preload is the volume of blood returning to the heart waiting to be ejected. Contractility is forced contraction, and afterload is resistance the heart has to push against. Starling's Law states the force of contraction is related to the myocardial fiber stretch prior to contraction.

Mean Arterial Pressure (02:29)

MAP is an indicator of perfusion to the vital organs. MAP is calculated using measured systolic and diastolic blood pressure values. Normal values of MAP are greater than 65.

Applied Patient Scenario (02:43)

Gilbert presents a case study in order to apply concepts of preload, afterload, and contractility. In septic shock patients, preload is increased, afterload is decreased, and contractility is increased.

Sepsis In Clinical Practice: Signs And Symptoms (02:33)

A history and physical of an 84 year old male presenting with abdominal pain, vomiting, and fever is described to set a scenario.

Sepsis in Clinical Practice: Lab Findings (01:50)

Gilbert reviews the key lab finds in the scenario of the 84-year-old male presenting with abdominal pain, vomiting, and fever. GFR levels are low and indicate progressive kidney disease. Blood gases indicate the patient has respiratory acidosis and hypoxia.

Stable vs. Unstable (01:21)

Initial treatments for sepsis include three and six hour bundles, fluids, and antibiotics. Based on the lab findings, the patient in the scenario is unstable. Treatment for his respiratory state includes noninvasive positive pressure ventilation or mechanical ventilation.

Sepsis: The Basics (05:55)

Sepsis is a consequence of a dysregulated inflammatory response to an infectious insult. qSOFA is an assessment tool used to facilitate the identification of patients at risk of dying from sepsis. Septic shock is sepsis that has circulatory, cellular, and metabolic abnormalities associated with a greater risk of mortality.

Risk Factors for Sepsis (02:00)

ICU admission, bacteremia, advanced age, immunosuppression, diabetes, cancer, community acquired pneumonia, and previous hospitalization are risk factors for sepsis.

Clinical Presentation of Sepsis (03:54)

Gilbert reviews the clinical signs and symptoms associated with sepsis. Critical thinking skills are explored to inform healthcare providers in understanding underlying risk factors for sepsis.

Laboratory Signs (02:34)

Lab results for patients with sepsis include leukocytosis, leukopenia, arterial hypoxia, increase in creatinine, coagulation abnormalities, thrombocytopenia, and elevated lactate.

Best Practice Initial Management (04:08)

Sepsis campaigns have established best practice management for sepsis begins with stabilizing respiration, establishing venous access, volume resuscitation, antibiotics, and labs.

Monitoring of Patients With Sepsis (02:10)

Continuous monitoring points with patients with sepsis include mean arterial pressure, urine output, vital signs, CVP, lactate, arterial blood gases, and evaluating the initial therapy.

Vasopressors vs. Inotropic Drugs (03:52)

First line vasopressors are norepinephrine, which elevate MAP by increasing vasoconstriction. Additional therapies include glucocorticoids, inotropic therapy, and red blood cell transfusions. Inotropes increase cardiac contractility.

Different Receptors (02:22)

Alpha receptors cause contraction whereas beta receptors cause dilation. When stimulated, dopamine receptors produce vasodilation.

Managing the Original Scenario (01:32)

Gilbert revisits the original 84-year-old case study and explores proper management of the patients disease process.

Arterial Blood Gases (07:18)

The key elements of ABG's are the pH, partial pressure of carbon dioxide, and partial pressure of oxygen. Gilbert interprets sample blood gas results.

NPPV vs. Mechanical Ventilation (09:21)

Non-invasive positive pressure ventilation is a form of mechanical ventilation that provides respiratory assistance without an artificial airway. Mechanical ventilation is delivered using assist control ventilation or pressure support ventilation.

Guidelines for Ventilators (01:35)

The goal of ventilation is adequate oxygenation and ventilation. Guidelines for ventilators include selecting the appropriate ventilator mode, initial FiO2 and tidal volumes.

Ventilator Complications (03:05)

Risks of ventilation include vent associated pneumonia, volutrauma, barotrauma, biotrauma ,cardiovascular compromise, and GI complications. The rapid shallow breathing index is the ratio of the frequency to tidal volume.

ARDS (03:59)

ARDS is pulmonary edema caused by increased alveolar capillary membrane permeability. ARDS is classified by severity including mild, moderate, and severe.

Management of ARDS (03:16)

Management of ARDS is multifaceted, but focuses on supportive care and preventing further complications.

Back To Our Patient (09:40)

Gilbert reviews the case of the patient with respiratory acidosis and explores the red flags for sepsis and multi-system organ dysfunction.

Review Sepsis (04:25)

Sepsis has a high risk or mortality and knowing the signs, symptoms, and risk factors of sepsis saves lives.

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Sepsis Survival

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Management of sepsis is a complicated clinical challenge requiring early recognition and management of infection, hemodynamic issues, and other organ dysfunctions. In this video, Robin Gilbert shares new tips to help pick up on clinical signs/symptoms that could indicate a concern. She teaches how to apply hemodynamic basics to a patient with sepsis. The video discusses the incidences of sepsis and septic shock and considers stabilization, diagnostics, medications, and ventilatory support for patients with sepsis.

Length: 92 minutes

Item#: BVL148855

ISBN: 978-1-64347-509-7

Copyright date: ©2017

Closed Captioned

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