Flashcards in Sepsis Deck (43)
What is sepsis?
systemic inflammatory response syndrome (SIRS) due to known or suspected infection
NOT a positive blood culture (aka bacteremia)
Can sepsis occur without dissemination?
T or F. Bacteremia can be tranisent
T. Even is normal conditions (i.e. straining to go No. 2) you can get some
How common is sepsis?
leading cause of death in critically ill patients (210,000 deaths/year)
Patient population for sepsis?
Nonwhite persons, and men (because androgens are more pro-inflammatory than estrogens)
What group of bacteria are the most common cause of sepsis?
T or F. Early mobilization is good even in sepsis
Trends with sepsis
-fungal causes on the rise
-in-hospital mortality and length of hospital stay falling
What is 'severe' sepsis defined as?
sepsis + organ failure
What is 'septic shock' defined as?
severe sepsis plus refractory hypotension which persists despite giving 30cc/kg of fluid and require vasopressors
How is sepsis defined?
life-threatening organ dysfunction cause by a dysregulated host response to infection
What NON-infectious etiologies can cause SIRS?
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)
What are some noninfectious causes of SIRS?
T or F. Many patients with sepsis do not become febrile
What are some patient populations that can have afebrile SIRS?
-CKD (especially on dialysis)
-Strokes/brain malfunction (hypothalamus damage)
need an immune response!
What is the purpose of fever?
enhances immune system ability to handle infection (phagocytosis, Ab binding is more optimal)
Sepsis = what?
SIRS + infection
What causes hypotension in septic shock?
vasodilation and increased permeability
What kind of shock is septic shock?
Ex. of obstructive shock
Why would you see tachycardia in SIRS?
reflex of hypotension
T or F. Sepsis can be associated with mental status change
T. Poor prognosis
Vomiting is one of the very first signs of infection in which patients?
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
What is the 'silver day' of sepsis?
notion that early treatment makes for the best prognosis
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%
What is a normal SvO2?
65-70% and decreased when oxygen delivery is inadequate
SvO2 can be corrected in sepsis by doing what?
optimizing Hb and/or CO