Sepsis Flashcards
(36 cards)
What is the definition of sepsis?
life-threatening organ dysfunction caused by a dysregulated host response to infection
How is organ dysfunction secondary to sepsis defined?
increase of >2 points in SOFA score
How is septic shock identified?
- clinically identified as patients meeting criteria for sepsis who, despite fluids,
- require vasopressors to maintain MAP >65
- AND have a lactate > 2mmol/L
How is SIRS defined?
2/4 of these
- Temp >38C
- HR >90bpm
- RR >20
- WBC >12,000
Based on Sepsis 2.0 definition how are the following defined:
a. sepsis
b. severe sepsis
c. septic shock
a. sepsis = SIRS + infection
b. severe sepsis = sepsis + organ dysfunction
c. septic shock = sepsis + decrease BP refractory to bolus of IVF (30cc/kg)
* last stage is MODS
What is the sepsis bedside criteria (e.g. qSOFA) ? (think: HAT)
qSOFA = Sepsis 3.0
- hypotension (SBP <100)
- altered mental status (GCS <15)
- tachypnea (RR >22)
What does qSOFA stand for?
- quick sepsis-related organ failure assessment
Based on sepsis 3.0 how is septic shock defined?
- Sepsis
- AND vasopressors to maintain MAP > 65mmHg
- AND serum lactate > 2
in the absence of hypovolemia
Based on the SOFA score how is organ dysfunction defined?
- an acute change in total SOFA score >2 points
What is the difference in accuracy between qSOFA and SIRS?
- qSOFA has poor sensitivity and moderate specificity
- SIRS has sensitivity superior to that of qSOFA
What is the spectrum of pathophysiology of sepsis?
Infection > dysregulated host response > sepsis > septic shock > MODS > death
How has the evolution in therapy for sepsis evolved?
goal-directed therapy > early goal-directed therapy > NOW: EARLY THERAPY
What were the essential elements of care for sepsis 2.0? (6 part)
- not including: early identification
- antibiotics within 1 hour
- initiate EGDT within 2 hours
- central line within 2 hours
- CVP 8-15 within 6 hours
- ScVO2 >70% within 6 hours
- MAP >65 within 6 hours
What are the essential elements of care for sepsis 3.0?
IN 1 HOUR
- ED Triage time to antibiotics
- blood cultures BEFORE antibiotics
- use broad spectrum antibiotics
IN 3 HOURS
- lactate within 3 hours
- give 30ml/kg bolus to increase BP
IN 6 HOURS
- vasopressors to goal MAP >65
- recheck lactate
- reassess volume status and tissue perfusion
What is the goal urine output when treating sepsis?
> 0.5 mL/kg/h (~30cc/hr)
MAGIC NUMBER = 30cc/hr
What is the most common static measure of volume and perfusion assessment?
lactate clearance
*CMS wants <2.0 mmol/L
What are the 3 common dynamic measures of volume and perfusion assessment?
- fluid challenge
- passive leg raise
- bedside cardiac echo (IVC variation)
What does lactate identify?
global hypoperfusion
Lactate of ____ doesn’t go to the floor. but survival drops quickly when it is > _____
Lactate of 4 doesn’t go to the floor. but survival drops quickly when it is > 2
CVP is used to determine what component of stroke volume?
preload
ScVO2 correlates to what?
delivery of oxygen (DO2)
*DO2 basically = CO
A SVO2 > ____ % indicates a normal extraction.
> 75%
A SVO2 of ____ % indicates compensatory increase in O2.
50-75%
A SVO2 of ____ % indicates exhaustion of extraction and the beginning of lactic acidosis.
30-50%
