Flashcards in EXAM #1: SEPSIS Deck (14)
What is the definition of SIRS?
Systemic Inflammatory Response Syndrome characterized by 2+ of the following:
1) Temperature greater than 38 C (101.4F) or less than 36 C (96.8)
2) HR greater than 90
3) RR greater than 20 or PaCO2 less than 32
4) WBC greater than 12K or less than 4,000K
What is sepsis?
SIRS + identified infection
What is severe sepsis?
Sepsis with evidence of organ dysfunction evidenced by:
1) SBP less than 90 or 70 MAP
2) Elevated Lactate
3) UOP less than 0.5mg/kg/hr
4) ALI with PaO2/FiO2 less than 250
5) Bilirubin greater than 4.0
6) Creatinine greater than 2.0
7) Platelets less than 100,000
What is septic shock?
Sepsis and hypotension DESPITE adequate fluid resuscitation
What type of shock is seen in sepsis?
What is the cascade of pathophysiological events that occurs in sepsis?
1) Distributive shock
2) Mycocardial depression
3) Bone marrow suppression
4) Activation of the clotting cascade (DIC)
5) Organ dysfunction
What are the most common causes of sepsis?
UTI and pneumonia
What labs should be ordered for the patient with sepsis?
1) CBC (lymphocytes, anemia, DIC)
3) Bicarbonate (metabolic acidosis)
4) Lactate (hypoperfusion)
7) PT, PTT, INR
In regards to antibiotics, what do you need to do first?
What has been shown to improve mortality in sepsis?
Early antibiotics i.e. within 1 hour of arrival to the hospital
What is the APACHE score used to determine?
- Severity of sepsis
- Aggressiveness of treatment
Summarize the goals sepsis therapy as determined by the 2001 review.
1) MAP of 65 mmHg or greater
2) Initial fluid challenge of 30 mL/Kg
3) NE first line for sepsis refractory to initial fluid challenge
4) Early initiation of antibiotic therapy (1 hour)
- Broad and then de-escalate
*Central line is not absolutely necessary
What is more efficacious, monotherapy vs. combination therapy?