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Flashcards in Adult Sepsis Deck (27)
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1
Q

define sepsis

A
  • life-threatening organ dysfunction caused by a dysregulated host response to infection.
  • aka: sepsis is a life-threatening condition that arise when the body’s response to an infection injures its own tissues and organs
2
Q

Those more likely to be affected by sepsis

A
  • extremes of age
  • weakened immune system
  • have wounds/injuries
  • drug/ETOH abusers
  • receiving IVs, wound drainage, urinary caths,
  • chronically ill pts
  • recent illness
  • genetic factors
3
Q

presentation of sepsis

A
  • cool, pale extremities
  • high/low temp (chills)
  • lightheaded
  • low BP, esp when standing
  • rapid HR or palps
  • low/absent UO
  • decreased intake/appetites, esp in neonates
  • altered mental status**
  • SOB
  • skin rash/discoloration
4
Q

predispositions to sepsis

A
  • trauma
  • DM
  • leukemia
  • nursing home residents
  • grannulocytopenia (splenectomy)
  • GU extension (cath)
  • pneumonia
  • radiation
  • longterm steroids
  • immunosuppresive agents
  • liver abscess
  • F gyn
5
Q

why do septic pts get hypovolemic?

A
  • blood pools in microcirculation –> loss of intravascular space fluid
  • d/t increased permeability: leaky capillary; fluid in wrong space
6
Q

systemic sx of sepsis

A
  • rigors
  • fever (+/-)
  • hypothermia
  • petechiae
  • leukocytosis
  • leukopenia
  • left shift CBC
7
Q

localized sx of sepsis

A
  • abdominal pain
  • perirectal abscess
  • penumonia, loculation, lung abscess
  • occult: urinary, biliary, pelvis, retroperitoneal
8
Q

toxic shock syndrome causative organism

A

staph

9
Q

presentation of TSS

A
  • usu w/i 5 days of period d/t tampon use (not as common any more)
  • n/v/d, thrombocytopenia, rash
  • blood cultures rarely positive
10
Q

what differentiates sepsis from infection?

A

an aberrant or dysregulated host response and the presence of organ dysfunction

11
Q

if unexplained organ dysfunction . . .

A

SUSPECT infection

12
Q

purpose of qSOFA

A

initially evaluates for poor outcome in infected pts

13
Q

criteria of qSOFA

A
  • new/worsened altered mentation
  • RR > 22
  • systolic BP < 100

*each equals 1 pt if yes

14
Q

qSOFA scoring: 2 or more

A
  • a score of 2 or more: high risk of poor outcome - assess for organ dysfunction
  • also calculate SOFA score
  • pts should receive standard interventions for sepsis: flui resuscitation, abx, source control
15
Q

qSOFA scoring: < 2

A
  • does not immediately suggest that a pt is not at high risk
  • if clinician is concerned, cont. w/ standard management of pts w/ suspected sepsis
16
Q

adult SIRS criteria

A
  • 2 or more of:
  • temp > 38 or < 36
  • HR > 90
  • RR > 20 or PaCO2 < 32
  • WBC > 12k or <4k or >10% immature bands
17
Q

adult sepsis w/u

A
  • CBC w/ diff
  • blood cultures
  • UA and culture
  • CMP
  • CXR
  • Lactic acid level** serial to monitor

**if indicated: LP; amylase/lipase; sputum culture

18
Q

LP is a diagnostic tool to r/o what?

A
  • meningitis

- subarachnoid hemorrhage

19
Q

LP is a therapeutic tool for what?

A

pseudo tumor cerebri

20
Q

steps in a CSF lab analysis

A
  1. opening pressure
  2. orders written as follows according to tube collection sequence:
    #1: cell count and differential
    #2: protein and glucose
    #3: gram stain and culture
    #4: hold
  3. note appearance of fluid - color and clarity
21
Q

tx of sepsis

A
  • fluids
  • inotropes if fluids not working (pressors)
  • IV abx - empiric initially then check sanford guide/sepsis handbook
  • surg if specific location to remove
22
Q

definition of septic shock

A
  • subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality
  • “a state of acute circulatory failure”
23
Q

how to ID pts w/ septic shock

A

-clinical construct of sepsis w/ persisting hypotension requiring vasopressors to maintain MAP > 65mm Hg AND having serum lactate level > 2 mmol/L despite adequate volume resuscitation

24
Q

hospital mortality rate when a pt is considered in septic shock

A

in excess of 40%

25
Q

Grading level of hypotension in adult sepsis

A
  • none: 0
  • MAP < 70: 1
  • on pressors, dopa < 5ug/kg/min or dobutamine: 2
  • on dopa > 5ug/kg: 3
  • on dopa > 15ug/kg: 4
26
Q

grading level of renal function in adult sepsis

A
  • Cr < 1.2: 0
  • Cr 1.2-1.9: 1
  • Cr 2.0-3.4: 2
  • Cr 3.5-4.9: 3
  • Cr > 5.0: 4
27
Q

What is the new focus of the 2016 SOFA / qSOFA scoring?

A
  • less on screening for a very strict definition of sepsis

- more on ID which pts w/ infections may have a poor outcome