Sepsis & Septic Shock

Question 1

Define shock in both words and by levels

Answer 1

Hypotension resulting in hypoperfusion of the tissues/organs. Results in organ damage and dysfunction.

Levels: SBP<90 mmHg OR decrease of 40 mmHg from baseline, MAP <65

Question 2

What kind of organ dysfunctions may result from septic shock?

Answer 2

Encephalopathy
AKI
Hepatitis
GI
Arrhythmias, ischemia, cardiac arrest
Respiratory failure

Question 3

What are the HEMODYNAMIC goals for septic shock treatment?

Answer 3

MAP ≥ 65
HR < 100 bpm
SvO2 ≥ 65% OR ScvO2 ≥ 70%

Question 4

What is the RENAL goal for septic shock treatment?

Answer 4

Urine output > 0.5 mL/kg/hr

Question 5

What is the OXYGEN DEFICIENCY RECOVERY goal for septic shock treatment?

Answer 5

Lactate normalizes < 2 mmol/L

Question 6

What are the treatments of septic shock?

Answer 6

Correct underlying cause (Abx, source control)
Fluids
Vasopressors
Inotropes
Corticosteroids

Question 7

What is the difference between sepsis and septic shock?

Answer 7

Sepsis: life-threatening organ dysfunction caused by body’s response to infection

Septic shock: subset of sepsis involving profound circulatory, cellular and metabolic abnormalities

Question 8

What two criteria tools can be used to identify sepsis?

Answer 8

qSOFA (rapid bedside score): 2+ of these = SBP < 100 mmHg, RR > 22, altered mental status

SIRS criteria [NOT sepsis specific]: 2+ of these = febrile or low temp, HR > 90 bpm, RR > 20, WBC > 12 or < 4

Question 9

What are risk factors for MRSA in sepsis?

Answer 9

Hx of MRSA colonization
Recent abx use
Hx of SSTIs
Hx of invasive devices
HD
Recent hospital admissions
Severity of illness

Question 10

What are risk factors contributing to multi-drug resistance?

Answer 10

Hx of colonization with resistant organisms in last year
Recent broad spectrum IV abx within 90 days
Travel to highly endemic country within 90 days
Local geographic resistance
Hospital-acquired infection

Question 11

1 L of crystalloid fluids translates to _____ mL intravascular volume

Answer 11

250 mL

Question 12

What is the dosing for fluid therapy in sepsis?

Answer 12

30 mL/kg over 15-30 mins + 10 mL/kg boluses

Question 13

If a patient is actively bleeding/hemorrhaging during sepsis, what product should you give?

Answer 13

PRBC (packed RBCs) and FFP (fresh frozen plasma)

Question 14

______ lines can be placed for constant BP monitoring, _______ ________ _________ are required for administration of vasopressors if MAP remains < 65 mmHg after fluids

Answer 14

Arterial lines = consistent BP monitoring
Central venous catheters = for pressor admin

Question 15

What corticosteroid may be may be used in septic shock? When in the treatment process should it be considered?

Answer 15

Hydrocortisone (+ fludricortisone)
- regulates inflammatory state
- inhibits nitric oxide
- increases Na+ and water retention

Used LAST LINE if fluids and pressors exhibit poor response

Question 16

Why is hydrocortisone preferred over fludricortisone in the setting of septic shock?

Answer 16

Hydrocortisone is equal parts glucocorticoid and mineralocorticoid, having dual action. Meanwhile fludricortisone is predominantly mineralocorticoid.