Flashcards in Sepsis Deck (25)
What is sepsis?
SIRS due to infection (proven or suspected)
What are the criteria for SIRS?
Two or more of:
1. temp >38 or Less then 36
Hr greater than 90
3. RR >20
4. WBC >12000 or 10%bands
Non-infectious causes of SIRS:
1. tissue injury (MI, pancreatitis, trauma, etc)
2. metabolic (thyroid storm, acute adrenal insuff)
3. therapy related (cytokines e.g. GM-CSF, opiates, blood products)
4. malignancy (tumor lysis synd)
5. neurologic (subarach hemorrhage)
What are possible factors that may contribute to afebrile infections in septic patients?
1. extremes of age
2. chronic kidney disease or uremia
5. DM (due to leukocyte dysf)
6. Neuro insults (stroke or malformations may result in damage to fever resp area)
Earliest and very sensitive test for sepsis
What is severe sepsis?
sepsis plus either:
-evidence of hypoperfusion or hypotension
What is septic shock?
-a subset of severe sepsis
-sepsis + hypotension not responding to fluid resuscitation
IL-1, IL-6, IL-8, TNF-alpha
What is the pathogenesis of septic shock?
in response to blood stream invasion, the host's defense system is activated; this causes release of cytokines and inflammatory mediators
If inflammatory response is...
1. excessive--results in inflammatory response
2. inadequate--results in ongoing release on microbial toxins
Results in tissue injury, then shock/MOF
Clinical manifestations of sepsis
-tachycardia (due to change in preload)
-mental status change
-loss of appetite (or "not tolerating feeds")
How much time do you have to detect and treat sepsis?
"silver day" (**6 hours is best)
What improves outcomes, in terms of sepsis?
Sepsis work-up before starting antibiotics?
gram stain and culture
blood cultures x2 (periph and via vasc access)
imaging (CXR, CT, etc)
What are 4 ways to manage sepsis (broad)?
1. eradicate microorg
2. neutralize microbial toxin
3. modulate host response
4. supportive care (for MOF/shock)
What antibiotic can decrease toxin production?
Goals of **Early Goal Directed Therapy** (4)
1. central venous pressure: 8-12 mmHg
2. MAP >65 mmHg
3. urine output >0.5 mL/kg/hr
4. central venous O2 sat >70%
(8-12=central venous pr,70=O2, 65=map, .5=pee)
Why is adequate urine output important to monitor?
it is a good measurement of general organ perfusion
What should antibiotics be given to a potentially septic patient?
immediately!! every hour delay increases mortality by 6-7%
In septic shock, low dose ____ improves mortality.
Who should get pneumococcal vaccine?
1. >65 y/o
2. 2-64 y/o with immunosuppression
3. 2-64 y/o with heart dis, lung dis, sickle cell, DM, ETOH, CSF leak, cirrhosis, cochlear implant
4. 19-64 y/o smoker or asthma
5. residents of NH or long term care facility
Resuscitation fluid of choice?
T/F: Early goal directed therapy improves mortality
Preventive measures in sepsis:
1. hand washing
2. DVT prophylaxis
3. stress ulcer prophylaxis (H2 blocker or PPI)
4. Head of bed elevation to prevent VAP
5. Remove foley and central lines ASAP
6. Early ambulation and PT
7. Target glu <150, hand washing, elevate head, DVT prophylaxis
(LAUGHED: lines, ambulation, ulcers, glu, hands, elevate, DVT)