Sepsis Part 1 Flashcards
(86 cards)
1
Q
Bacteremia: Define
A
Bacteria in the blood stream
2
Q
Bacteremia: Bacteremia can be transient. What does this mean?
A
- It is short-lived in the blood stream
3
Q
Bacteremia: Bacteremia can be transient. What are causes of transient bacteremia?
A
- Tooth brushing - UTI
4
Q
Bacteremia: Bacteremia resulting from a UTI may cause an “overwhelming bacteremia.” This condition results in what common lab finding and what signs and symptoms?
A
- (+) Blood cultures - Fever - Chills
5
Q
Bacteremia: (T/F) Overwhelming bacteremia may lead to sepsis.
A
- TRUE
6
Q
Bacteremia: (T/F) Bacteremia is most often transient in nature.
A
- TRUE
7
Q
Sepsis: Define
A
- Systemic response to infection
8
Q
Sepsis: Severe complications?
A
- Organ failure
- Death
9
Q
Sepsis: How many people in the US annually develop sepsis?
A
- 1.5 million people
10
Q
Sepsis: How many people in the US annually die from sepsis (at least)?
A
- 250,000 * Different sources vary based on coding
11
Q
Sepsis: Mortality rate?
A
-40%
12
Q
Sepsis: What is the old definition (~1992 until ~2016) of severe sepsis?
A
Severe sepsis Infection + SIRS + organ dysfunction
- SIRS in the setting of infection, when associated with acute organ dysfunction, is called severe sepsis.
13
Q
Sepsis: What is SIRS?
A
- Systemic inflammatory response syndrome
14
Q
Sepsis: What is the updated (2016) definition of sepsis?
A
- Life-threatening Organ dysfunction caused by dysregulated host response to infection.
15
Q
Sepsis: What is the big difference between the 2016 definition of sepsis and the “old” definition of sepsis?
A
- 2016 definition removes the SIRS criteria
16
Q
Sepsis: What is the updated (2016) definition of septic shock?
A
- Subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound and increase mortality.
17
Q
Organ dysfunction: What tool are we able to use to identify organ dysfunction early on in sepsis?
A
- SOFA score
18
Q
Organ dysfunction: Define organ dysfunction in terms of sepsis.
A
- Identified as an acute change in SOFA score
19
Q
Organ dysfunction: What does SOFA score stand for?
A
- Sequential Organ failure Assessment score
20
Q
SOFA score: What systems are considered when calculating this score?
A
- Respiration - Coagulation - Liver - CV - CNS - Renal
21
Q
SOFA score: What objective lab value is used to assess respiration in the SOFA score?
A
- PAO2 - FIO2
22
Q
SOFA score: What is the PaO2/FiO2 ratio? Why is it helpful?
A
- Ratio of arterial oxygen partial pressure (PaO2 mmHg) to fractional inspired oxygen (FiO2) - Expressed as a fraction, not a percentage - AKA “the P/F ratio” - It is a widely used clinical indicator of hypoxemia, though its diagnostic utility is controve
23
Q
SOFA score: What lab value is used to determine the coagulation score?
A
- Platelets
24
Q
SOFA score: What lab value is used to determine the liver score?
A
- Bilirubin
25
SOFA score: What value is used to determine the CV score?
- Mean arterial pressure
26
SOFA score: What value is used to determine CNS score?
- Glascow Coma Scale (GCS)
27
SOFA score: What lab values are used to determine the renal score?
- Creatinine
| - Urine output
28
SOFA score: (T/F) SOFA score is most commonly utilized in the outpatient clinic environment.
- False * It's difficult to get an ABG in an outpatient setting, so it's actually rarely utilized in an outpatient medical environment.
29
SOFA score: What is the assumed baseline score of any patient without sepsis?
- zero
30
SOFA score: a score greater than or equal to ___ reflects an overall mortality risk of 10% in a hospitalized patient.
- (greater than or equal to) 2
31
SOFA score: Because SOFA scores are difficult to perform in an outpatient setting, what score was created specifically to remedy this situation?
- qSOFA score * quick SOFA score
32
qSOFA score: (T/F) The qSOFA score has all of the same systems involved as the SOFA score but the lab values associated with the respiratory system is different.
- FALSE
33
qSOFA score: What are the components of the qSOFA score?
- Respiratory rate - Altered mental status - Systolic blood pressure
34
qSOFA score: What are you assessing with the respiratory rate?
- Greater than or equal to 22 is considered a positive
35
qSOFA score: How are you assessing altered mentation in a qSOFA score?
- GCS < 13 is a positive
36
qSOFA score: What is the cut-off value associated with the SBP being a positive indicator in the qSOFA score?
- SBP less than or equal to 100 mmHg
37
qSOFA score: How many of the three systems involved in the qSOFA score need to be positive for the provider to suspect a likely poor outcome with this patient?
- Any 2 out of the 3
38
Severe sepsis: This condition results from the body's over-response to infection. The complications encountered with this condition can be described as a disruption of ___.
homeostasis
39
Severe sepsis: How is homeostasis disrupted?
- Inflammation activated
- Coagulation activated
- Fibrinolysis suppressed
- Coagulopathy
40
Severe sepsis: What component of a disrupted homeostasis is the driving force of acute organ dysfunction and death?
- Coagulopathy
41
Inflammation: (T/F) Inflammation is a normal response to infection.
- TRUE
42
Inflammation: How do Gram negative organisms activate inflammation?
- Via their lipopolysacharide wall
43
Inflammation: (T/F) Gram positive organisms cannot cause inflammation because they do not have the lipopolysacharide wall that Gram negative organisms do.
- FALSE * It just occurs through a different mechanism of action
44
Inflammation: How is inflammation activated by sepsis?
- Proinflammatory mediators
- TNF
- Interleukins
- Platelet activating factor
45
Inflammation: The term "inflammation" is Latin: "to set on fire." That said, what are the classic signs of inflammation?
- Rubor - Calor - Tumor - Dolor
46
Inflammation: A more commonly used term for rubor?
- Redness
47
Inflammation: A more commonly used term for calor?
- Heat
48
Inflammation: A more commonly used term for tumor?
- Swelling
49
Inflammation: A more commonly used term for dolor?
- Pain
50
Proinflammatory mediators: function?
- Repair existing damage and limit new damage
51
Proinflammatory mediators: What is the "check system" in place for the interleukin system?
- to down-regulate initial Proinflammatory response.
52
Proinflammatory mediators: Which interleukins are used to down-regulate the initial proinflammatory response?
- IL4 - IL10
53
Inflammation: (T/F) In sepsis, regulation of early response to infection is amplified.
- FALSE - Regulation of early response to infection is LOST.
54
Inflammation: What protein(s) and cytokine(s) are released in excess as a result of the massive systemic reaction that occurs in sepsis?
- TNF - IL1 - IL6
55
Inflammation: What is the direct result of excess TNF, IL1, and IL6 released into the bloodstream?
- Excess tissue injury
| - Diffuse capillary injury
56
Inflammation: Excess TNF, IL1, and IL6 leads to excess tissue injury and diffuse capillary injury. This process is known as what?
- Cytokine storm
57
Inflammation: Complications from a cytokine storm?
- tissue damage - Organ dysfunction
58
Coagulation: (T/F) The inflammatory mediators released to fight infection also activate coagulation.
- TRUE
59
Coagulation: How does the infectious agent itself promote coagulation?
- Via the endothelial damage It may cause
60
Coagulation: The presence of d-dimer indicates what process?
- the activation of clotting
61
Coagulation: What event causes activation of coagulation factors?
- blood contacting damaged tissue
62
Fibrinolysis: Describe purpose.
- the normal process to remove clots
63
Fibrinolysis: (T/F) This process is suppressed in sepsis.
- TRUE
64
Fibrinolysis: What protein is the key inhibitor of fibrinolysis?
- Plasminogen activator inhibitor-1 (PAI-1)
65
Fibrinolysis: What cells produce PAI-1?
- endothelial cells
66
Fibrinolysis: Endotoxins are released by Gram negative rods. Does this decrease or increase the activity of PAI-1?
- increase
67
Microcirculation: What is the microcirculatory system responsible for?
- the transport of oxygen to tissue throughout the body
| * Microcirculatory function is essential for adequate tissue oxygen delivery and, thus, Organ function
68
Microcirculation: How does injury to the microvascular impact the presence of neutrophils?
- Increased neutrophil migration and adhesion
69
Microcirculation: How does injury to the microvascular impact the process of coagulation at the site of injury?
- Increased Coagulation
70
Microcirculation: How does injury to the microvascular impact the process of fibrinolysis at the site of injury?
- Decreased Fibrinolysis
71
Microcirculation: How does injury to the microvascular impact the process of inflammation at the site of injury?
- Increased Inflammation
72
Microcirculation: Complications of injury to the microvascular system?
- endothelial injury
- Loss of barrier integrity
- Altered Microcirculatory perfusion
73
Results of sepsis: How is oxygen delivery impacted? Why?
- Decreased oxygen delivery - capillary damage
74
Results of sepsis: How is cardiac output impacted by sepsis?
- Decreased cardiac output
75
Results of sepsis: Describe the change in aerobic and/or anaerobic metabolism that takes place.
- Increased anaerobic metabolism
76
Results of sepsis: What metabolite is increased as a direct result of the increased anaerobic metabolism?
- Lactic acid
77
DIC: What does this stand for?
- Disseminated Intravascular Coagulation
78
DIC: Describe this process.
- Widespread imbalance between Inflammation, Coagulation, and Fibrinolysis
79
Lab findings in DIC: What parameters associated with coagulation are elevated in DIC?
- PT - PTT - Fibrin monomers - D-dimers
80
Lab findings in DIC: What parameters associated with coagulation are decreased in DIC?
- Protein C - Fibrinogen - Platelet count
81
Lab findings in severe sepsis: What markers and/or findings are elevated in severe sepsis?
- Creatinine
- ALT, AST, T bili
- Lactate
- Procalcitonin
82
Lab findings in severe sepsis: Why would creatinine be elevated in severe sepsis?
- Sign of Renal failure
83
Lab findings in severe sepsis: Why would ALT, AST, and T bili be elevated in severe sepsis?
- Sign of hepatic failure
84
Lab findings in severe sepsis: An elevated lactate is a lactate over what value?
> 2 mmol/L
85
Lab findings in severe sepsis: An elevated procalcitonin is a procalcitonin over what value?
> 2.0 ng/mL
86
Lab findings in severe sepsis: What markers and/or findings are decreased in severe sepsis?
- Urine output - mental status - blood pressure
