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CDM > SEPSIS > Flashcards

SEPSIS Flashcards

1
Q

What is Sepsis?

A

Life-threatening organ dysfunction caused by dysregulated host response to infection

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2
Q

What is Bacteremia?

A

Bacteria in the bloodstream

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3
Q

T/F: Bacteremia can be transient or overwhelming?

A

True.

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4
Q

Is a UTI a transient or overwhelming bacteremia?

A

Transient

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5
Q

Signs of Overhwhelming Bacteremia

A

(+) BCx, Sx

Fever, chills

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6
Q

SEPSIS SxS

A 
Shivering/Fever
Extreme Pain
Pale skin
Sleepy/confused
"I feel like I might die"
SOB
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7
Q

Sepsis v Septic Shock.

A 
Septic shock can progress quickly
Inability of body to compensate.
- Lactic acid >2
-HYPOTENSION
(MAP <65)
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8
Q

Severe Sepsis definition

A

Infection + SIRS+Organ dysfunction

“SIRS” in the setting of infection, assoc w/acute organ dysfunction

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9
Q

How do we quantify organ dysfunction?

A

Acute change in SOFA score

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10
Q

Septic Shock Definition. Key finding?

A

Subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound

HYPOTENSION

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11
Q

What is the Sofa Score?

What does a high score mean?

A

Sequential Organ Failure Assessment

High SOFA score means worse sepsis

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12
Q

Baseline SOFA score?

A

Baseline Sofa score is 0

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13
Q

How high does mortality risk increase with a SOFA score >2?

A

10% mortality risk in admitted pts

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14
Q

What lab value is not found in a sofa score?

A

lactic acid

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15
Q

is qSOFA sensitive enough to meet Sepsis Dx?

A

No

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16
Q

What are the disruptions to homeostasis in Severe Sepsis?

A

Inflammation activated
Coagulation Activated
Fibrinolysis Suppressed

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17
Q

What is the driving force in acute organ dysfunction and death?

A

Coagulopahty

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18
Q

What (Bacterial) cause of inflammation is activated in sepsis?

A 
Lipopolysaccharide wall
from gram (-) bacteria
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19
Q

What factors/mediators are released in response to sepsis?

A

Proinflammatory mediators, TNF, Interleukins, platelet activating factors

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20
Q

4 classic signs of Inflammation

A

Rubor-redness
Calor-Heat
Tumor- swelling
Dolor- Pain

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21
Q

Which mediators are responsible for cytokine storm?

A

Excess TNF, IL1 IL6

cause tissue & diffuse capillary injury

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22
Q

What are the 3 ways coagulation is activated in Sepsis?

A
  • Inflammatory mediators released to fight infect also activate coagulation
  • Infectious agent itself can cause endothelial damage=promotes coagulation
  • Factors activated upon blood contacting damaged tissue= more clotting
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23
Q

T/F: D-dimer is a screening tool for Sepsis

A

False

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24
Q

What is PAI-1?

A
  • Plasminogen activator inhibitor

- Key inhibitor of fibrinolysis in Sepsis

25
Q

What 2 factors increase PAI-1 activity in sepsis?

A
  • Endothelial cells

- Endotoxins released by gram (-) rods

26
Q

What are 2 reasons for increased anaerobic metabolism in sepsis?

A
  • Decreased O2 delivery because of capillary damage

- Decreased cardiac output

27
Q

What metabolite is increased in anaerobic metabolism

A

Lactic aid

28
Q

What disease state can result from Sepsis?

A

DIC

29
Q

What is SIRS in regard to sepsis?

A

systemic inflammatory response syndrome, an overwhelming response to infection
SIRS criteria: (2+ to meet criteria)
1. temp >100.4 or <96.8
2. HR > 90bpm
3. tachypnea-resp rate > 20 or PaCO < 32mmhg
4. >12,000 WBC, or <4,000, or > 10% immature neutrophils ie a left shift

30
Q

What do you need to confirm Dx of Sepsis?

A

SIRS + a suspected source of infection=confirm diagnosis of sepsis.

31
Q

SIRS clinical utility

A

SIRS is used as early recognition to make a diagnosis and early intervention to impact survivability

32
Q

What is DIC? What are the labs of DIC (high/low)?

A
  • Disseminated Intravascular Coagulation
  • Widespread imbalance between inflammation, coagulation and fibrinolysis

↑PT, PTT, Fibrin monomers, D-dimer

↓Protein C, Fibrinogen, Platelet count

33
Q

What are the labs/findings of Severe Sepsis (high/low)?

A

↑ Creatinine, ALT,AST, Total bilirubin, Lactate (>2 mmol/L),- Procalcitonin (>2.0 ng/ml)

↓ Urine output, Mental status, BP

34
Q

What is procalcitonin?

What level is indicative of Sepsis?

A

Protein biomarker→ bacterial infect
Utilized to deescalate ABX
> 2.0 ng/ml → highly suggestive Sepsis

35
Q

Severe Sepsis pts are lively to have (5)?

A 
↑ mortality rates
Long lengths of stay
↑ ventilator usage
↑ costs
↑ probability of outlier status
↓ payment-to-cost ratios (Low SES)
36
Q

Pts at risk for sepsis?

A
  • All critically ill
  • Severe CAP
  • Intra abdominal surgery
  • MENINGITIS
  • Chronic Disease (DM, HF, CRF and COPD)
  • ↓ immune function –HIV, transplants (Solid organ & blood), chemo
  • Cellulitis
  • UTI
37
Q

Decrease in what 2 findings can negate cessation of fluid rescuscitation?

A

↓ Cap refill time & ↓ Lactate

38
Q

What is the MCC of Severe Sepsis?

A

PNA

39
Q

Phases of Sepsis Management?

A 
1. Resuscitation Phase 
(6hrs-sooner=better –strive for 3hrs)
2. Initial Management Phase 
(24 hours)
3. Maintenance Phase 
(>24 hours)
40
Q

Resuscitation Phase algorithm

A
  1. Access & maintain airway
  2. BCx & Blood work
  3. Initiate ABX therapy
  4. IV fluids 30ml/kg
    (If MAP <65 or lactate >2)
  5. Tight glycemic control Insulin
    continuous IV drip
  6. Vasopressors-**NOREPINEPHRINE,
  7. Sedation?
  8. Steroids?
    use for pts in septic shock
41
Q

ABX therapy?

A

Broad Spectrum:
Vanco=gram (+), & resistant
gram (+)
Pip/tazo (Zosyn) =(-), anaerobes, Pseudomonas

can also use carbapenems (not ertapenem)

42
Q

Vasopressor therapy?

A

**Norepinephrine-use first
dobutamine, phenylephrine, epinephrine, vasopressin,

dopamine- use LAST

pts often need combo of pressors

43
Q

Goals of 1st 6hrs

A
  • *MAP <65
  • urine output 0.5mL/hr
  • Central venous O2 sat >70%
44
Q

Hour 1 bundle

A
  • Measure lactate level
  • Obtain BCx before admin of ABX
  • Admin broad spectrum ABX
  • Begin rapid admin of 30ml/kg crystalloid for hypotension or lactate>2
  • Maintain MAP ≥ 65 mmHg via Vasopressors
45
Q

Goals of Initial management phase?

A
  • Continue Rescusitation
  • Monitor ↓Cap refill time &↓Lactic acid to reduce fluids
  • Monitor Cx for ABX therapy
  • Constant monitor Vasopressors
  • Maintain MAP >65
46
Q

Types of Support in Management phase?

A

Respiratory support:

  • Watch for ARDS
  • ↑ HOB
  • Use weaning protocols

CNS Support (sedation protocols)

  • Avoid NM blockers if possible (in pts w/o ARDS)
  • Short course NM blocker for pt w/ early, severe ARDS
47
Q

Maintenance Phase goals?

A
  • Preventing nosocomial infections
  • Restore premorbid condition
  • Tailor antibiotic therapy as culture info available
48
Q

General supportive care in Maintenance phase sepsis

A
  • BGL <180 mg/dl
  • Dialysis for renal failure or fluid overload
  • DVT prophylaxis
  • Stress ulcer prophylaxis
    =Stress on GI system- sitting in pool of stomach acid
    (Tx: PPI’s)
  • Enteral feeding if possible
    tube feeds
49
Q

What bacteria are most common in Sepsis?

What sources for infection MC?

A 
Gram (-) rods,
Strep PNA (gram (+))

Lungs
Urinary tract
GI
Skin/Soft tissue

50
Q

T/F: COVID sepsis will have (+) BCx?

A

False

51
Q

How do we manage ICU pts w/severe COVID-19?

A

Recommend use of:

  • Corticosteroids (**dexamethasone)
  • VTE prophylaxis

Recommend Use in non ventilated pts:
- Remdisivir
-Recommend prone ventilation:
when ventilation is necessary

Recommend AGAINST use of:
- Hydroxychloroquine

52
Q

Severe sepsis is ____, ______, and ______.

A

Common
Deadly
Costly

53
Q

______ is key in sepsis tx

A

Early recognition

54
Q

1st signs of sepsis are _____
1st hours of sepsis are ______

_____ resuscitation is 1st step

A

Subtle
Crucial
Fluid

55
Q

MAP calculation?

A

(SBP+2DBP)/3

56
Q

Procalcitonin uses:

A 
Can detect severity of Bacterial infect
- higher number-more severe Dz
Role in ABX stuartship:
- When to start ABX
- to reduce or r/o ABX use
Also:
- Arthritis (infectious or not)
- Acute Endocarditis
- Meningitis (bacterial or not)
57
Q

MC bacteria for sepsis in neonates?

A

Ecoli, GBS = colonizations

Listeria = mom exposure

58
Q

How can mom be exposed to listeria?

What can Listeria cause?

A 
Soft cheeses (unpasteurized)
Deli Meat

Meningitis–>sepsis

59
Q

MC bacteria for sepsis in IVDU?

A

Staph/Strep & MRSA

CDM (16 decks)

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