Sepsis - Schoenwald

Question 1

What is bacteremia?

Answer 1

• -Bacteria in blood stream
• -Can be transient-tooth brushing

*overwhelming bacteremia results in + blood cultures, fever, chills

Question 2

______ is a systemic response to infection that can cause organ failure and death in severe cases

Answer 2

sepsis

Question 3

How do you quantify sepsis?

Answer 3

qSOFA

Question 4

A sofa score greater than ____ reflects an overall mortality risk of 10% in a hospitalized patient

Answer 4

2

Question 5

What are the three things measured in a qSOFA and what are the values?

Answer 5

• RR >/= 22
• GCS < 13
• SBP = 100

*Any 2 of 3 above likely to have a poor outcome

Question 6

Lactate ______ (inc/dec) in sepsis

Answer 6

Increases

Question 7

What happens in sepsis that causes disruption in homeostasis and leads to organ damage?

Answer 7

• Inflammation activated
• Coagulation activated
• Fibrinolysis suppressed (so inc clotting risk)
• Coagulopathy

Question 8

________- is a key inhibitor or fibrinolysis in sepsis

Answer 8

PAI-1

Question 9

What are 4 systemic results of sepsis?

Answer 9

• Decreased O2 delivery because of capillary damage
• Decreased CO (so body inc HR)
• Increased anaerobic metabolism
• DIC

Question 10

What findings are elevated in DIC?

Answer 10

PT, PTT, Fibrin, D-dimer

Question 11

What findings are decreased in DIC?

Answer 11

-Protein C, fibrinogen, platelet count

Question 12

What lab findings are elevated in sepsis?

Answer 12

-Cr, ALT, AST, T bili, lactate, procalcitonin

Question 13

What lab findings are decreased in sepsis?

Answer 13

-urine output, mental status, BP

Question 14

What level of lactate is indicated in sepsis? what level is very worrisome?

Answer 14

> 4 and worrisome = 5

Question 15

What is procalcitonin?

Answer 15

It is the earliest marker or a bacterial infection. It rises quickly with bacteremia and decreases after initiation of abx

• –Used to know when to stop abx basically
• Not helpful in viral causes that turn into sepsis

Question 16

What level of procalcitonin is suggestive of sepsis?

Answer 16

Values > 2.0

Question 17

What is the #1 cause for severe sepsis?

Answer 17

Community acquired pneumonia (Gram + strep)

Question 18

What three demographics are at greater risk for sepsis?

Answer 18

• Older age 65 +
• Underlying comorbidity
• higher body weight

Question 19

What symptoms does the SEPSIS acronym stand for?

Answer 19

S- shivering, fever, very cold
E- extreme pain
P- pale or mottled skin 
S- sleepy, confused 
I- I feel like I might die 
S- SOB

Question 20

What is the SIRS criteria?

Answer 20

Systemic Inflammatory Response System >/= two

• Temp >100.4 or <96.8
• HR > 90
• Tachypnea RR > 20 or PaCO2 <32
• WBC > 12,000

Question 21

What is the mc cause of severe sepsis?

Answer 21

Pneumonia (CAP)

Question 22

What does the Screening for Severe Sepsis for patients include?

Answer 22

Infection + SIRS + Acute Organ Dysfxn

Question 23

What is the mc bacteria in neonatal sepsis?

Answer 23

GBS & E. coli

*really important to check b=mom for this before delivery (can treat with PCN)

Question 24

What is the MC cause of sepsis in an IV drug user?

Answer 24

Staph aureus and MRSA

Question 25

What is the length of sepsis tx for a normal patient? and for an IVDU?

Answer 25

4 to 6 and 2 wks

Question 26

What is the resuscitation phase?

Answer 26

1st 6 hrs/ sooner the better - really the goal is less than an hour

Question 27

What is the initial management phase?

Answer 27

24 hrs

Question 28

What is the maintenance phase?

Answer 28

> 24 hrs

Question 29

What is the most important initial step in the resuscitation phase?

Answer 29

Access and maintain airway

Question 30

What is an initial appropriate antibiotic therapy in the resuscitation phase?

Answer 30

Vanco +pip/tazo OR carbapenem * *Remember ernapenem does not have pseudomonas coverage * If you find out organism is gram +, you don't need carbapenem

Question 31

What is the initial volume of IV fluids that should be given if MAP <65 or lactate >4 ?

Answer 31

30 ml/kg

Question 32

When should 30 ml/kg IV fluids be started?

Answer 32

MAP <65 or lactate >4

Question 33

What meds are used to keep MAP > 65?

Answer 33

Norepi (preferred) and dopamine (discouraged)

Question 34

When do you add steroids in sepsis?

Answer 34

Adrenal insufficiency

Question 35

What drug should not be used in sepsis because it can't get into the lungs?

Answer 35

Daptomycin

Question 36

What IV fluids are best to use in sepsis?

Answer 36

LR or NS (crystalloids) *D5W not a good option because you lose glycemic control

Question 37

Are crystalloids or colloids preferred in sepsis?

Answer 37

Crystalloids

Question 38

What MAP do you want to maintain in sepsis?

Answer 38

MAP > 65

Question 39

What are the steps in hour 1 bundle: initial resuscitation?

Answer 39

1. Measure lactate level 2. Obtain blood cultures before admin of abx 3. Admin broad spectrum abx 4. Begin rapid admin of 30 ml/kg crystalloids for hypotension or lactate >4 5. Maintain MAP >65 with vasopressors (NE preferred)

Question 40

In a patient with early, severe ARDS, what med should you give?

Answer 40

Neuromuscular blockers (not for pts without ARDS)

Question 41

What blood gluocse do you want to keep a patient with sepsis at?

Answer 41

<180

Question 42

What med for DVT prophylaxis in sepsis?

Answer 42

Lovenox

Question 43

What med for stress ulcer prophylaxis in sepsis?

Answer 43

PPI or H2 blocker

Question 44

What 3 bacteria are most common in sepsis?

Answer 44

S. pneumo, staph aureus (gram +) and e. coli (gram -)

Question 45

Tx for ICU or covid sepsis patients?

Answer 45

corticosteroids or dexameth NOT hydroxychloroquine Remdesivir in non-ventilated pts

Question 46

________ is the only anti-fungal that gets into the bladder

Answer 46

fluconazole