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Flashcards in Sepsis Deck (43):
1

What is sepsis?

systemic inflammatory response syndrome (SIRS) due to known or suspected infection

NOT a positive blood culture (aka bacteremia)

2

Can sepsis occur without dissemination?

Yes

3

T or F. Bacteremia can be tranisent

T. Even is normal conditions (i.e. straining to go No. 2) you can get some

4

How common is sepsis?

leading cause of death in critically ill patients (210,000 deaths/year)

5

Patient population for sepsis?

Nonwhite persons, and men (because androgens are more pro-inflammatory than estrogens)

6

What group of bacteria are the most common cause of sepsis?

gram +

7

T or F. Early mobilization is good even in sepsis

T.

8

Trends with sepsis

-fungal causes on the rise
-in-hospital mortality and length of hospital stay falling

9

What is 'severe' sepsis defined as?

sepsis + organ failure

10

What is 'septic shock' defined as?

severe sepsis plus refractory hypotension which persists despite giving 30cc/kg of fluid and require vasopressors

11

How is sepsis defined?

life-threatening organ dysfunction cause by a dysregulated host response to infection

12

What NON-infectious etiologies can cause SIRS?

-pancreatitis
-burns
-trauma
-organ rejection

13

How is SIRS defined? criteria

two or more of:
1. Temp over 38C or under 36C
2. Heart rate 90+ bpm
3. Tachypnea, RR over 20
4. WBC over 12k or less than 4k (OR 10+%bands)

14

What are some noninfectious causes of SIRS?

-blood transfusion
-surgery
-many others

15

T or F. Many patients with sepsis do not become febrile

T.

16

What are some patient populations that can have afebrile SIRS?

-extreme age
-immunocompromised
-corticosteroids
-NAIDS/acteaminophen use
-CKD (especially on dialysis)
-Diabetes uncontrolled
-Strokes/brain malfunction (hypothalamus damage)

need an immune response!

17

What is the purpose of fever?

enhances immune system ability to handle infection (phagocytosis, Ab binding is more optimal)

18

Sepsis = what?

SIRS + infection

19

What causes hypotension in septic shock?

vasodilation and increased permeability

20

What kind of shock is septic shock?

distributive

21

Ex. of obstructive shock

pulmonary embolism

22

Why would you see tachycardia in SIRS?

reflex of hypotension

23

T or F. Sepsis can be associated with mental status change

T. Poor prognosis

24

Vomiting is one of the very first signs of infection in which patients?

kids

25

In the ICU, another manifestation of sepsis is not tolerating feed well. How does this manifest?

Gastric residuals- this is a quantifier that can be measured by a nurse and if the food is going where it should be, this should be very low

26

What is the 'silver day' of sepsis?

notion that early treatment makes for the best prognosis

27

What are some of the goals of fluid directed treatment of sepsis?

-central venous pressure of 8-12 mm Hg
-MAP greater than 65 mm Hg
-Urine output more than 0.5ml/kg/hr
-central venous O2 saturation over 70%

28

What is a normal SvO2?

65-70% and decreased when oxygen delivery is inadequate

29

SvO2 can be corrected in sepsis by doing what?

optimizing Hb and/or CO

30

What is another way to test whether oxygen is being delivered as intended?

lactic acid measurement

31

Each hour delay in ABX increases mortality by ____%

6-7

32

What kinds of lab work is needed before starting ABX in sepsis?

-2 sets of blood culture
-CBC
-CXR, CT scan

33

What are two ABX known to decrease toxin production?

Clindamycin and Linezolid

34

What fluids are used in sepsis?

Normal saline (albumin will work the same but way more expensive) or a crystalite

35

Why is called 'normal' saline?

it is isotonic

36

What is the pH of normal saline?

5.4, so more equals a higher risk of hyperchloremia and metabolic acidosis

37

AEs of normal saline?

-alterations in renal blood flow
-effect immune function

balanced fluids avoid these biochemical effects

38

Balanced fluids (sodium acetate/Lactoringer's provides a better response for sepsis. How?

Balancing pH as well as being isotonic

39

Why cant you just use Lactoringer's saline?

potassium levels may start to increase

40

What are some choices of vasopressor?

-Levophed better than Dopamine

at 20mics/min of Levophed, add vasopressin

41

Preventive measures in sepsis

-hand washing
-DVT prophylaxis
-stress ulcer prophylaxis
-head of the bed elevation
-chlorhexidine mouthwash
-remove foley cath and central lines ASAP
-early ambulation
-target glucose less than 150 mg/dL

42

Why do septic patients have hyperglycemia?

increased catecholamines cause increased gluconeogenesis and insulin resistance

43

Autopsy/Immunohistochemical studies of sepsis have shown which cell lines to be dying?

lymphocytes and GI epithelial cells