Exam 5 - Sepsis Flashcards Preview

Therapeutics V Spring 2019 (P3 Spring) > Exam 5 - Sepsis > Flashcards

Flashcards in Exam 5 - Sepsis Deck (67):
1

definition of bacteremia

presence of bacteria in the blood

2

definition of sepsis

life threatening organ dysfunction cause by dysregulated host response to infection

3

SIRS stands for?

systemic inflammatory response syndrome

4

Criteria for SIRS:
Temperature?

> 38 C or < 36 C

5

what are the 4 criteria looked at for SIRS

Temp
HR
RR (or PaCO2)
WBC (or bands)

6

how many of the 4 criteria do you need to have SIRS

just 2/4

7

Criteria for SIRS:
HR?

> 90 BPM

8

Criteria for SIRS:
RR?

> 20 breaths/min

9

Criteria for SIRS:
WBC?

> 12,000 or < 4000

10

need a ______ score to see if pt has sepsis

SOFA

11

Need a __#__ score in SOFA to have sepsis

2 or more

12

what does SOFA stand for

sequential (sepsis-related) organ failure assessment

13

Quick SOFA score (qSOFA): need ____ out ____ criteria means more likely to have poor outcomes

need 2 out of 3

14

what are the 3 criteria for qSOFA score?

altered mental status
Systolic BP < 100
RR > 22

15

definition of septic shock?

subset of sepsis
where underlying circulatory, cellular, and metabolic abnormalities are assoc. with high risk of mortality than sepsis alone

16

Septic Shock Pts:
Pts require _________ to maintain a _______ above 65
AND
_______ > 2 mmol/L ( >18 mg/dL)
in the absence of ________

require vasopressors; MAP;
serum lactate
hypovolemia

17

Factors leading to increased incidence of sepsis?

-immunocompromised pts
-frequent invasive device/procedures
-more life sustaining technology
-higher frequency of infections caused by abx resistant organisms
-Aging population with serious underlying conditions

(overall we are keep people alive longer.....)

18

what is the most common organism that causes sepsis?

enterobacteriaceae

19

what are examples of enterobacteriaceae

E. Coli
Klebsiella
Enterobacter
Serratia
Proteus

20

worrying about Pseudomonas aeruginosa in sepsis patients when?

mechanical ventilation
prolonged hospitalization
burn injury

21

Gram - or Gram + will cause sepsis more often and why?

Gram - because it has LPS/ENDOTOXIN!

22

definition of multiple organ dysfunction syndrome?

presence of altered organ function in an acutely ill patient so that homeostasis cannot be maintained w/out intervention

23

what does DIC stand for?

disseminated intravascular coagulation

24

conversion of prekallikrein to bradykinin leads to vasodilation or vasoconstriction?

dilation!
(like ACEI stuff = dilation = lover BP)

25

Issue of vasodilation with bradykinin?

increases capillary permeability = fluid leaks into interstitial space = septic shock

26

macrophages roll in sepsis?

remove/destroy bacteria
produce inflammation mediators

27

TNF-a stimulates the release of _________ and _______

PAF (platelet activating factor)
and
interleukins

28

TNF-a acts on the hypothalamus to cause ______

fever

29

what are antiinflammatory mediators?

IL-1ra and IL-10

30

Thromboxane A2 or PGI2:
which one causes platelet aggregation and which one inhibits it

thrombox: causes aggregation
PGI2: inhibits

31

General Variables of Criteria Sepsis:
Temperature: > ____C
HR > ______
(brady or tachy) pnea
altered mental status
significant _______
(hypo or hyper) glycemia

> 38.3 C
> 90 bpm
TACHYpnea
edema
HYPERglycemia

32

what inflammatory marker correlates to bacterial load, severity of infection, and mortality and we use for monitoring need of antibiotics

PCT (procalcitonin)

33

For PCT Concentration:
when value is _______ antibiotics are DISCOURAGED

< 0.5 ng/mL
(if < 0.25 STRONGLY discouraged....)

34

For PCT Concentration:
when value is _______ antibiotics are ENCOURAGED

when > 0.5 ng/mL
(when > 1 STRONGLY encouraged)

35

what are things to look at to see if there are any tissue perfusion variable?

hyperlactatemia (> 1 mmol/L)
decreased capillary fill

36

Things that could indicate Organ dysfunction:
A SCr change of what?

increase of more than 0.5

37

Things that could indicate Organ dysfunction:
Arterial _____oxemia

hypoexmia

38

Things that could indicate Organ dysfunction:
Acute ____uria

oliguria

39

Things that could indicate Organ dysfunction:
________cytopenia
_______billirubinemia

thrombocytopenia (plt ct < 100,000)
hyperbilirubienmia (total bilirubin >4)

40

what things need to happen in the first 3 hours of sepsis?
-measure _______ concentration
-obtain ________ prior to administration of abx
-administer __________
-administer _________ for _________

-measure lactate concentration
-obtain blood cultures prior to administration of abx
-administer broad spec abx
-administer crystalloids (normal saline or lactated ringer) for hypotension

41

what things need to happen in the first 6 hours of sepsis?
- apply _______ to maintain MAP > 65 mmHg
- re-assess ________ and _______ (if initial lactate was high)
- re-measure ______ if initially elevated

- apply vasopressors to maintain MAP > 65 mmHg
- re-assess volume status and tissue perfusion (if initial lactate was high)
- re-measure lactate if initially elevated

42

most likely bacteria to cause urogenital infections?

E. Coli!!!!
Klebsiella
Enterobacter
Serratia
Pseudomonas

43

most likely bacteria to cause respiratory infections (nosocomial)?

pseudomonas!!
S. aureus
klebsiella
enterobacter
E. Coli
serratia

44

most likely bacteria to cause respiratory infections (community)?

S. pneumoniae
Legionella pneumophilia
H. influenzae
C. pneumoniae

45

most likely bacteria to cause bowel infections?

Bacteriodes
E. Coli
Klebsiella
Enterobacter
Serratia

46

most likely bacteria to cause biliary tract infections?

E. Coli
Klebsiella
Enterobacter
Serratia

47

most likely bacteria to cause reproductive system infections?

Bacteriodes
E.Coli
Gram +

48

most likely bacteria to cause skin infections?

gram +
pseudomonas
acinetobacter
klebsiella
enterobacter
serratia

49

For Sepsis -- Disease specific treatments:
if CAP?

since sepsis know is ICU pt....
will give either Ceftriaxone + azithromycin OR
Ceftriaxone + respiratory FQ

50

what FQs are ok to use for CAP?

moxifloxacin or levofloxacin

NOT cipro

51

For Sepsis -- Disease specific treatments:
If suspected urinary tract source?

3rd/4th gen ceph
Pip/tazo

52

For Sepsis -- Disease specific treatments:
if suspected intra-abdominal source?

pip/tazo
carbapenem
3rd/4th gen ceph + metronidazole
Cipro or levo + metronidazole

53

For Sepsis -- Disease specific treatments:
if suspected skin/soft tissue infection/cellulitis?

vanc
linezolid
daptomycin

54

For Sepsis -- Disease specific treatments:
for hospital acquired infection: suspected pneumonia

(antipseudo beta lactam) + (aminoglycoside or antipseudomonal FQ) +
(vanc or linezolid)

55

For Sepsis -- Disease specific treatments:
for hospital acquired infection: suspected UTI

Cefepime + AG or FQ
Pip/tazo + AG or FQ

(want pseudomonas coverage)

56

For Sepsis -- Disease specific treatments:
for hospital acquired infection: suspected intra-abdominal infection

pip/tazo
carbapenem (NOT erta!!)
(want pseudomonas coverage)

57

For Sepsis -- Disease specific treatments:
for hospital acquired infection: suspected skin and soft tissue infections?

vanc + pip/tazo (+ clindamycin if necrotizing fasciitis)

58

For Sepsis -- Disease specific treatments:
for hospital acquired infection: if suspected indwelling vascular catheter infection

vanc
dapto
linezolid

59

how to treat sepsis?

7 - 10 days

60

Vasopressor Facts:
target a MAP of ______

65 mmHg

61

Vasopressor Facts:
________is a first choice drug

NE (norepinephrine)

62

Glucose control and sepsis?

do NOT tightly control it!!!
issues of hypoglycemia happen a lot

63

Use corticosteroids in sepsis?

yes!

64

DVT prophylaxis for sepsis pts?

yes -- LMWH or LDUH (low dose unfractionated heparin)

65

best to limit nutrition or increase nutrition with sepsis patients?

more increase/maintain for sure because sepsis is high expenditure

66

other options than NE for vasopressor?

epinephrine
vasopressin
dopamine
phenylephrine

67

how to find MAP?

diastolic P + (1/3)(systolic P - diastolic P)