SEPSIS

Question 1

Sepsis-3 Definitions for sepsis

Answer 1

Sepsis:
Life-threatening organ dysfunction caused by a dysregulated host response to infection

Question 2

Sepsis-3 - Septic Shock def’n

Answer 2

Septic Shock:
subset of sepsis with circulatory and cellular metabolic dysfunction associated with higher risk of mortality

sepsis + inability to maintain MAP >65 without vasopressors AND Lactate>2 **despite adequate fluid resus

Question 3

List the categories of sepsis ( historical def’n in 2012 vs Sepsis 3 in 2016)

Answer 3

historical (2012)
-sepsis
-severe sepsis
-septic shock

sepsis 3 (2016)
-sepsis
-septic shock

Question 4

Historical (2012) definitions of sepsis

Answer 4

Sepsis:
>/= 2 SIRS criteria
suspect infection

Severe Sepsis:
Sepsis + organ dysfunction:
-AMS
-O2<90%
-hypotension
-AKI
-U/O <0.5 cc/kg/h x2h
-lactate >2
-Plt <100
-Bili >34
-INR>1.5

Septic Shock:
-sepsis
-hypotension (SBP<90)
AFTER “adequate” fluid resus

Question 5

SIRS Criteria

Answer 5

> /= 2 of
-RR>20 or PaCO2<32
-HR >90
-Temp <36 or >38
-WBC <4 or >12, or >10% bands

Question 6

What is the purpose of the 3 prognostic scores (SIRS, aSOFA, NEWS2)?

Answer 6

-identify patients who are at high risk of adverse outcomes, to allow us to advocate for expediated/escalating care
-predict in-hospital morality and prolonged ICU stay

NOT identify sepsis

Question 6

What is the 1-h bundle?

Answer 6

1. Measure a lactate and re-measure if initial is >2 (w/in 2-4h)
2. obtain cultures
3. broad-spec ABx
4. 30 cc/kg crystalloid for hypotension or lactate >4
5. start vasopressors if pt is hypotensive DURING or AFTER fluid resus to target MAP >/= 65