Infectious Disease Flashcards
(14 cards)
What are the criteria for SIRS (Systemic Inflammatory Response Syndrome)
SIRS Must have ≥2 of:
SangraPumper (Heart) > 90 bpm
Immune (WBC) external to 4-12K (or > 10% immature bands)
Respiratory rate > 20 (or PaCO2 < 32)
Surrounding Temperature external to 36-38C
SIRS + infection = Sepsis
Screen these pts with POC Lactate as they may only come in with malasie, fatigue or weakness!
Which organisms usually cause UTI-associated Sepsis?-4
KEEP away, UTI!
Klebsiella
E.Coli
Enterococcus
Proteus
Empiric Abx for Sepsis -4
Choose one from the Kumar study…
- CefTriaxone
- Zosyn
- Aztreonam
- Carbapenem
Complications of PNA -3
- SEPSIS
- Parapneumonic effusion–> Empyema
- Pulm vessel infiltration –>Seeding (Heart, Meninges)
Consider these when pt treated for PNA isn’t getting better
Name the common sources to check for infection - 5
BURST
- Blood (get blood cx x 2)
- Urine
- Respiratory (PNA)
- Spinal fluid (meningitis/encephalitis)
- Tucked away (endocarditis, bone, septic arthritis, intraabd abscess)
What does SEVERE Sepsis mean? ; List the 7 examples
Sepsis + end-organ dysfunction
System, Liver, Kidney
- Lactate≥2
- Systolic<90 (or MAP<70)
- Bilirubin>2
- Platelet<100K
- INR>1.5 (or aPTT>60s = coagulopathy)
- Cr>2
- UOP<0.5 cc/kg/hr for > 2 hr
What does Septic SHOCK mean?
Pt still has Systolic<90 DESPITE IVF OF 30cc/kg
What serves as the primary method of risk stratification pts coming in with sepsis? Why?
Lactate
It is a marker of anaerobic glycolysis during insuffucient O2 delivery. High Lactate = High mortality
Do NOT use old blood samples to draw Lactate
[T or F] Delaying Abx during sepsis tx is dangerous to the pt
FALSE - there’s little change in mortality if you delay giving abx so get other data first (CXR, UA) to determine cause before giving abx
Per the Surviving Sepsis Campagin:
Describe the 3 hour tx bundle
Vasopressors = VELDS
Per the Surviving Sepsis Campagin:
Describe the 6 hour tx bundle
Vasopressors = VELDS
***In the ED, goal of getting [Lactate < 2] or [⬇︎Lactate by 10%] is the same as Scvo2≥70% ***
“C”VP and Scvo2 are no longer suggested to be monitored in most pts. Volume status reassessment can be done with something else
Per the Surviving Sepsis Campagin:
During the 6 hour tx bundle, which vasopressors can be used to achieve MAP ≥ ___
Vasopressors = VELDS for getting MAP≥65
- Vasopressin
- Epi
- Levophed
- Dopamine
- Steroids
Nearly all pts with sepsis syndromes will require hospitlization
Which pts should be admitted to an ICU? - 2
Pts with
- Lactate≥4
- Vasopressor dependent hypotension
Others (Normotensive post intervention lactate <2) typically go to step-down or regular nursing floors. Postintervention pts with Lactate 2-3 receive ICU consult
SIRS+ pt becomes hypotensive 60 min after receiving abx
Is this common or uncommon?
COMMON - and is the reason reassess pts frequently is necessary
