Sepsis

Question 1

In which gender does sepsis more commonly affect?

Answer 1

Males

Question 2

What is the general trend of sepsis diagnosis? Why?

Answer 2

Going up

Patients are living longer

Question 3

What is SIRS?

Answer 3

Systemic inflammatory response syndrome

Question 4

What are the four criteria that define SIRS?

Answer 4

1. Temp more than 101.4 F or less than 96.8 F
2. HR more than 90
3. RR more than 20 or PaCO2 less than 32
4. WBC more than 12 or less than 4

Question 5

What is the range of temperatures that define SIRS?

Answer 5

Less than 96.8 or more than 101.4

Question 6

What is the HR that defines SIRS?

Answer 6

More than 90 bpm

Question 7

What is the RR that defines SIRS?

Answer 7

more than 20 breaths per minute

Question 8

What is the PaCO2 that Defines SIRS?

Answer 8

Less than 32 mmHg

Question 9

What is the WBC count that defines SIRS?

Answer 9

More than 12, less than 4, or bandemia of more than 10%

Question 10

How many criteria of the SIRS definition must be met to diagnose SIRS?

Answer 10

2 of the 4 AND suspected or identified infection

Question 11

What are the BP ranges that define hemodynamic compromise?

Answer 11

Less than 90 SBP
MAP less than 70
SBP decrease by 40

Question 12

What lab value is used to assess for general organ dysfunction?

Answer 12

Lactate

Question 13

What is the UOP that defines organ dysfunction?

Answer 13

Less than 0.5 mg/kg/hr for 2 hours despite adequate hydration

Question 14

What are the pulmonary criteria for end organ dysfunction?

Answer 14

PaO2/FiO2 less than 250 or 200 in absence/presence of PNA respectively

Question 15

What bili level indicates liver dysfunction?

Answer 15

More than 4

Question 16

What CrCl level indicates renal dysfunction?

Answer 16

More than 2

Question 17

What is the definition of septic shock?

Answer 17

Sepsis + hypotension despite resuscitation measures

Question 18

What is the sepsis continuum?

Answer 18

SIRS
Sepsis
Severe sepsis
Septic shock

Question 19

What are the two major pathophysiological factors that affect sepsis prognosis/severity?

Answer 19

1. Pathogen features

2. Host features

Question 20

What causes the decreases systemic vascular resistance in sepsis?

Answer 20

Proinflammatory cytokines

Question 21

What is distributive shock?

Answer 21

Peripheral vasodilation causes an acute drop in BP, leading to reflex tachycardia

Question 22

What are the three most common etiologies of septic shock?

Answer 22

UTIs
Pneumonia
GI infx

Question 23

What are the ssx of sepsis (mnemonic of SEPSIS)?

Answer 23

Shivering
Extreme pain
Pale
Sleepy
Impending doom
SOB

Question 24

Lymphedema from working in the garden = ?

Answer 24

Sporotrichosis

Question 25

Bowel ruptures should be treated for what type of bacteria?

Answer 25

Gram negative anaerobes

Question 26

What is one of the first organs to be affected in septic shock? What lab value is used to evaluate this?

Answer 26

Kidneys | CrCl

Question 27

What does a HCO3 level tell you?

Answer 27

Acidosis/alkalosis

Question 28

Why get coags for sepsis?

Answer 28

Determine if DIC is present

Question 29

What is the best timeframe for the delivery of abx for a septic pts?

Answer 29

Within 1 hour

Question 30

What are the most common infectious agents that mediate sepsis? (5)

Answer 30

``` Staph aureus Strep Pneumoniae E. Coli Klebsiella Pseudomonas ```

Question 31

What percent of blood cultures are positive in septic patients?

Answer 31

only 1/3

Question 32

What is the lab value that can be used to evaluate for rhabdomyolysis?

Answer 32

CK

Question 33

What is the equation for MAP during sepsis?

Answer 33

SABP + 2xDABP / 3 65 mmHg

Question 34

True or false: with appropriate cuff measurements, BP readings can be as accurate as central line measurements

Answer 34

True

Question 35

What type of IVFs are the initial treatment of choice for sepsis? HOw much should be administered?

Answer 35

Crystalloids 30 mL/kg

Question 36

How long should IVFs be run with Sepsis?

Answer 36

As long as showing continuing ssx of improvement

Question 37

Why start a central line for sepsis?

Answer 37

If giving pressors or large boluses of meds. However, PICCs can get IVFs nearly as quickly

Question 38

What happens if MAP is still not at the goal after 30 ml/kg of IVFs?

Answer 38

Diagnose septic shock

Question 39

What is the best pressor?

Answer 39

NE

Question 40

What, besides NE, can be used for pressors?

Answer 40

Epi Vasopressin Dopamine Phenylephrine

Question 41

True or false: vasopressin is a first line pressor

Answer 41

False-- do not use it first

Question 42

Which type of abx therapy is better for gram negatives: mono or combination therapy?

Answer 42

Combo

Question 43

How important is it to ensure that lactate levels fall with treatment of sepsis?

Answer 43

Very--tells you how effective resuscitation measures are

Question 44

What are the four things to be completed within 3 hours of presentation of sepsis?

Answer 44

1. Lactate levels 2. Blood cultures 3. Abx 4. IVF (30ml/kg)

Question 45

What are the three things to be completed within 6 hours of presentation of sepsis?

Answer 45

1. Apply pressors if needed 2. Assess tissue perfusion 3. Remeasure lactate

Question 46

True or false: a physician's assessment is equivalent to obtaining additional labs for assessing for adequate tissue perfusion

Answer 46

True