Flashcards in PATHOPHYS: Sepsis Deck (26):
True or false: the majority of patients with sepsis have a positive blood culture.
What is the definition of sepsis?
Systemic inflammatory response syndrome (SIRS) due to an infection (proven or suspected)
The rate of sepsis due to what organisms has risen 207%?
What are the predominant pathogens that cause sepsis?
gram positive bacteria
List the 4 conditions that can define SIRS (if 2 are met).
1) Temp >38 or 90
3) Tachypnea >20
4) WBC >12,000 or 10% bands
What is the major cytokine that can produce SIRS?
Which groups of patients with sepsis do NOT become febrile?
patients with uremia
If you see a respiratory rate of 20, what should you do?
you should retake it--it is probably wrong
What is severe sepsis?
sepsis plus either organ dysfunctionor evidence of hypoperfusion or hypotension
What is septic shock?
sepsis-induced hypotension (persisting despite adequate fluid resuscitation)
If a patient has septic shock, what drug is required to reverse the hypotension?
Describe the pathogenesis of septic shock.
-Nidus of infection
-Blood stream invasion
-Host defense system activated and mediators are released (cyclic reaction)
-Shock or multiorgan failure ensues
How do cytokines cause shock?
they lead to mitochondrial dysfunction that causes tissue injury
What are two reasons sepsis may produce mental status change?
1) brain hypoperfusion
2) brain dysfunction (due to mitochondrial damage)
List some symptoms of sepsis.
Not tolerating feeds (ICU patients)
Why do you get hypotension in sepsis?
vasodilation and increased vascular permeability
What is the "silver day" for sepsis?
Perspective that early resuscitation improves outcome
What lab work should be done before starting antibiotics?
1) Gram stain and culture of body fluids
2) Blood cultures (peripherally AND through vascular access device)
3) Imaging (CXR, CT, and HIDA scan to rule out cholecystitis)
What drugs can be given to neutralize gram negative microbial toxins or TSS?
-Clindamycin and Lineolazid (immediately stop toxin production)
-IV-Ig will bind to toxin
List the criteria in goal-directed resuscitation.
-CVP 8-12 mmHg
-MAP > 65 mmHg
-Urine output > 0.5 mL/kg/hr
-Central venous O2 saturation >70%
Why do you want an increased CVP in sepsis patients?
make use of Frank-Starling law to increase perfusion (by increasing stroke volume)
What can cause central venous O2 saturation to decrease?
-Decreased cardiac output
-Increased metabolism (extraction of oxygen by tissues)
-Decreased O2 carrying capacity (anemia)
When should you start antibiotics on a septic patient?
by at least 4 hours (every hour delay increases mortality 6-7%
What is the first thing you do to a septic patient?
replace fluids (normal saline then Ringer's lactate)--CRYSTALLOIDS
Along with fluids and antibiotics, what other drug class has been found to improve outcomes for septic patients?
Low dose hydrocortisone