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Infeksjonsmedisin > Sepsis - Amboss > Flashcards

Sepsis - Amboss Flashcards

1
Q

Hva er “Third International Consensus Definitions for Sepsis and Septic Shock”?
- “The adoption of these definitions in a clinical setting remains somewhat controversial.”

A
Definitions and criteria in this section apply to adult patients. The presence and degree of organ dysfunction are determined using the Sequential Organ Failure Assessment (SOFA) score.
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2
Q

Hvilke andre definisjoner opererer man med når det kommer til sepsis syndrom?
- “These previously used definitions are not considered useful according to the 2016 consensus. However, they are still widely used in clinical practice.”

A
The 2016 Sepsis-3 consensus discourages using SIRS criteria to define sepsis as they have low specificity (i.e., parameters can be positive in multiple other critical illnesses). They nevertheless remain commonly used in clinical practice in the US. Severe sepsis is no longer included in the Sepsis-3 definitions but is still commonly used in clinical practice. The 2016 Sepsis-3 consensus recommends assessing organ dysfunction with the SOFA (Sequential Organ Failure Assessment) score.
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3
Q

Hva er vanlige, bakenforliggende årsaker til sepsis?

System

A
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4
Q

Hvilke typer patogener kan gi sepsis?

A
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5
Q

Hvilke risikofaktorer for sepsis er identifisert?

A
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6
Q

Fyll inn

A
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7
Q

Hvilken patofysiologi har sepsis?

A
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8
Q

Fyll inn figuren
Hva viser den?

A
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9
Q

Hvordan er den generelle klinikken ved sepsis?

A
Fever may be absent in neonates, severely immunosuppressed patients, and older patients. Diaphoresis; The secretion of sweat from sweat glands. Sometimes used to refer to excessive sweating.
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10
Q

Hvilken klinikk ved sepsis er tegn på organdysfunksjon?

A
Sepsis is one of the leading causes of ARDS. Oliguria; The production of an abnormally small amount of urine that is quantitatively defined as urine output of < 400 mL per 24 hours in adults (less than 0.5 mL/kg/h in children).
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11
Q

Hva er SOFA skår?

A
SOFA score should not be used to diagnose sepsis.
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12
Q

Hvilke underpunkter består SOFA skåren av?

A

Respirasjon

Koagulasjon

Lever

Kardivaskulæresystemet

CNS

Nyrefunksjon

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13
Q

Hvordan skårer man respirasjonen ved bruk av SOFA?

A
PaO2; Partial pressure of oxygen in arterial blood (Arterial partial pressure of oxygen, PaO₂): The partial pressure of oxygen in arterial blood. Depends on the partial pressure of oxygen in the alveoli, the diffusion coefficient of the alveolar membrane, and the ventilation-perfusion ratio. A rough estimate of the expected PaO₂ in a normal individual is five times that of the concentration of oxygen in inhaled air (FiO₂). FiO2; Fraction of inspired oxygen: The fraction of oxygen (by volume) in inspired air. Room air has an FiO₂ of 21%. Supplemental oxygen can be provided at varying levels of FiO₂ depending on the indication; e.g., an FiO₂ of 100% is often used in emergencies.
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14
Q

Hvordan måler man koagulasjonen ved bruk av SOFA skåren?

A
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15
Q

Hvordan ser man etter leversvikt ved bruk av SOFA skår?

A
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16
Q

Hvordan beregner man verdien, ved bruk av SOFA skår, av det kardiovaskulære systemet?

A
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17
Q

Hva bruker man for å finne SOFA skåren på virkningen av sentralnervesystemet?

A
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18
Q

Hvilket parameter bruker man for å finne SOFA skåren for nyresvikt?

A
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19
Q

Fyll inn

A
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20
Q

Hvordan er klinikken ved septisk sjokk?

A
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21
Q

Hvordan er klinikken på den primære infeksjonen hos en pasient?

Sepsis

A
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22
Q

Hva viser bildet?

A
23
Q

Hva viser bildet?

A
24
Q

Hvordan er den initielle vurderingen av en pasient med mistenkt sepsis?

A
Sepsis is a medical emergency! Be vigilant for early signs of sepsis and begin treatment as soon as sepsis is suspected.
25
Q

Hvordan bør den initielle behandlingen av en septisk pas. foregå?

A
26
Q

Etter den initielle behandlingen hos en septisk pas., hva er neste steg?

A
Hemodynamic parameters; To guide further fluid and vasopressor management. E.g., removal of infected central lines, surgical consult for excision of infected tissue.
27
Q

Hva er “Hour-1 bundle for sepsis”?

A
Repeat if initial lactate is > 2 mmol/L. In patients with a low PTP of sepsis and no shock, antibiotics can reasonably be delayed until after diagnostic confirmation for up to 3 hours.
28
Q

Hva er målet med de diagnostiske testene man utfører ved sepsis?

A

The main goals of the diagnostic workup in a patient with suspected sepsis are to determine the presence and severity of organ dysfunction and to identify the source of infection.

Remember; Positive cultures are not mandatory for the diagnosis of sepsis.

29
Q

Hva er målet med screeningverktøy ved sepsis?

A

Tidlig identifikasjon av pasienter med sepsis for å redusere mortaliteten

30
Q

Hvilke vanlige screeningsverktøy for sepsis bruker man i klinikken?

A
The choice of sepsis screening tool varies by the institution; follow local protocols. Screening is considered positive if ≥ 2 SIRS criteria are fulfilled. These criteria are commonly used in clinical practice despite their low specificity.
31
Q

Hvilke labprøver er aktuelle hos en pas. med mistanke om sepsis?

A
Procalcitonin may be used to support the decision to terminate antibiotic therapy in patients with good clinical progress. Glucose; Due to glucose dysregulation. Both hyperglycemia and hypoglycemia can be seen in diabetic and nondiabetic patients. Blood gas; Respiratory failure can cause respiratory acidosis or mixed metabolic acidosis.
32
Q

Hvordan kan man identifisere årsaken til infeksjonen ved en sepsis?

A
CSF; If there is a concern for meningitis or encephalitis. Tissue/fluid; If there is abscess drainage, debridement.
33
Q

Hvilke typer bildemodaliteter er akt. ved en septisk pas.?

A
CT scan; E.g., lung abscess, intraabdominal abscess, necrotizing pancreatitis.
34
Q

Hvordan går man fram med væskebehandlingen ved sepsis?

A
The following recommendations are consistent with the 2021 Surviving Sepsis Campaign. Some experts advocate using alternative strategies that have a lower risk of fluid overload.
35
Q

Hva er indikasjonen og målsetningen ved den vasoaktive behandlingen av septisk sjokk?
Hva er førstelinjepreparatet man velger å bruke?

A
The following recommendations are consistent with the 2021 Surviving Sepsis Campaign. If norepinephrine is not available, epinephrine or dopamine can be used instead, with increased vigilance for drug-induced dysrhythmias. Routine use of dopamine as a first-line vasopressor is not supported by the 2021 Surviving Sepsis Campaign.
36
Q

Hvordan kan man vurdere/revurdere hemodynamikken ved sepsis?

A
Includes serial lactate and lactate clearance.
37
Q

Hvordan gir man respiratorisk støtte til septiske pasienter?

A
38
Q

Når er det akt. å gi kortikosteroider til septiske pas.?

A
39
Q

Hvordan går man frem for å få kontroll på infeksjonen til en septisk pasients?

A
Shock or probable sepsis; E.g. obvious source of infection, acute abdomen. Source of infection; Consider common pathogens for the source of infection (if evident).
40
Q

Hvilke vanlige patogener forekommer i resporatoriske systemet?

Sepsis

A
41
Q

Hvilke bakterier er de vanligste ved UVI?

Sepsis

A
42
Q

Hvilke bakterier er vanlige ved intraabdominale infeksjoner?

Sepsis

A
43
Q

Hvilke patogene bakterier kan gi infeksjoner i bein- og bløtvev?

A
44
Q

Hvilke patogene bakterier kan gi infeksjoner i det kardiovaskulære systemet?

A
45
Q

Hvilken ab. behandling velger man å gi til en septisk pas. med ukjent infeksjonsfokus?

A
There is little consensus regarding the optimal empiric antibiotic regimens for patients with sepsis and septic shock, especially if the source of infection is unclear. If the source of infection is clear, administer antibiotics that cover the most common causative pathogens.

https://www.legemiddelhandboka.no/T1.10/Sepsis

46
Q

Hvilke ab. typer er akt. hos pas. med økt risiko for enkelte patogener?

Resistens +++

A
Ticarcillin/clavulanate; Not available in the United States and Canada. Anaerobes; E.g., intraabdominal infections, some UTIs, abscesses.
47
Q

Hvordan kan man bekjempe infeksjonen til en septisk pas.?

Andre metoder som ikke er ab.

A
48
Q

Hvilken støttende behandling kan man gi en til en septisk pas.?

Utenom ab., væske +++

A
49
Q

Hvilke diff.diagnoser har man til sepsis?

A
50
Q

Hvilke vanlige komplikasjoner kan oppstå hos en septisk pas.?

A
51
Q

Hvilken type komplikasjon kan føre til aksonal skade, spesielt av motornevronene?

A
Critical illness myopathy; Usually occurs a few days after initiation of glucocorticoid therapy.
52
Q

Gi en oppsummering om sepsis

A
53
Q

Fyll ut figuren

A

Infeksjonsmedisin (14 decks)

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