Sepsis & Septic Shock & Antimicrobial Stewardship Flashcards
(27 cards)
What aer the signs that indicate SEPSIS?
Slurred speech/Confusion
Extreme shivering or muscle pain
Passing no urine all day
Severe breathlessness
It feels like you’re going to die
Skin mottled or discolored
What are the criteria of Sepsis?
Suspected infection and an acute increase in >2 sepsis-related organ failure assessment points
What are criteria of septic shock?
Suspected (or documented ifnection)
+
vasopressor therapy needed to maintain MAP @ 65mmHg & serum lactate >2.0mmol/L despite adequate fluid resuscitation
What are signs of SIRS?
Fever
Increase RR (>20bpm)
INC HR (>90bpm)
Leukocytosis (>12,000cells/mm3)
Leukopenia (<4,000cells)
0 to 4 pts per organ system of SOFA score
What are the most common infections precipitating sepsis?
1 = pneumonia
2 = UTI
What are the qSOFA variables involved?
RR >22bpm
Altered mentation
SBP <100mmHg
When do u designate sepsis-induced hypoperfusion?
(+) sepsis => hypotensive => check serum lactate => > or equal to 4mmol/L => sepsis-induced hypoperfusion
In inflammatory cascade, if the HYPOTHALAMUS is targeted by TNF or other proinflammatory cytokines, what can happen?
FEVER
TACHYCARDIA
TACHYPNEA
In inflammatory cascade, if the CAPILLARY ENDOTHELIAL CELL is targeted by TNF or other proinflammatory cytokines, what can happen?
Neutrophil migration
Platelet adherence
DIC
Depletion of intravascular vol
—> CELLULAR HYPOXIA -> Organ dysfunction/hypoperfusion -> Hypotension —> Death
In inflammatory cascade, if the VESSEL WALL is targeted by TNF or other proinflammatory cytokines, what can happen?
NO synthesis -> Vasodilation -> Cellular hypoxia -> Organ dysfunction/hypoperfusion -> Hypotension -> Death
What is the normal SOFA score?
0
In px with sepsis, what is the best test to determine effective and efficient blood flow around the body?
Capillary refill time = done in sternal area for 5 secs
What is the most common risk factor of serious sepsis?
Age
What are the core elements in managing sepsis and septic shock?
Resuscitation
Infection control
Respiratory support
General supportive care
What resuscitation fluid is used for septic shock management?
IV crystalloid fluid (within 3h) => saline or balanced cyrstalloid is recommended
What is the 1st choice vasoppressor in septic shock resuscitation?
Norepinephrine
what is used for reducing norepinephrine dose?
Vasopressin
What is given in septic shock resuscitation when px show persistent evidence of hypoerfusion despite adequate fluid loading & use of vasodepressors?
Dobutmine
When do you give RBC transfusion in septic shock resuscitation?
Hgb <7.0g/dL
(-) AMI, severe hypoxemia or acute hemorrhage
When do you assess and reassess fluid response during septic shock?
Take BP reading every hr
What test is done to monitor changes in blood flow or pressure to predict fluid responsiveness?
Passive leg raise test
What should u look out for during assessment of fluid responsiveness?
Spontaneou breathing
Cardiac arrhythmia
Low compliance/tidal volume <8mL/kg
What are assessed in fluid responsiveness by dynamic parameters?
Stroke volume variation
Pulse pressure variation
In severe cases of acute respiratry distress syndrome from sepsis/septic shock, what is a recommended maneuver?
Prone positioning
