Sepsis & Septic Shock & Antimicrobial Stewardship

Question 1

What aer the signs that indicate SEPSIS?

Answer 1

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

Question 2

What are the criteria of Sepsis?

Answer 2

Suspected infection and an acute increase in >2 sepsis-related organ failure assessment points

Question 3

What are criteria of septic shock?

Answer 3

Suspected (or documented ifnection)
+
vasopressor therapy needed to maintain MAP @ 65mmHg & serum lactate >2.0mmol/L despite adequate fluid resuscitation

Question 4

What are signs of SIRS?

Answer 4

Fever
Increase RR (>20bpm)
INC HR (>90bpm)
Leukocytosis (>12,000cells/mm3)
Leukopenia (<4,000cells)
0 to 4 pts per organ system of SOFA score

Question 5

What are the most common infections precipitating sepsis?

Answer 5

1 = pneumonia
2 = UTI

Question 6

What are the qSOFA variables involved?

Answer 6

RR >22bpm
Altered mentation
SBP <100mmHg

Question 7

When do u designate sepsis-induced hypoperfusion?

Answer 7

(+) sepsis => hypotensive => check serum lactate => > or equal to 4mmol/L => sepsis-induced hypoperfusion

Question 8

In inflammatory cascade, if the HYPOTHALAMUS is targeted by TNF or other proinflammatory cytokines, what can happen?

Answer 8

FEVER
TACHYCARDIA
TACHYPNEA

Question 9

In inflammatory cascade, if the CAPILLARY ENDOTHELIAL CELL is targeted by TNF or other proinflammatory cytokines, what can happen?

Answer 9

Neutrophil migration
Platelet adherence
DIC
Depletion of intravascular vol
—> CELLULAR HYPOXIA -> Organ dysfunction/hypoperfusion -> Hypotension —> Death

Question 10

In inflammatory cascade, if the VESSEL WALL is targeted by TNF or other proinflammatory cytokines, what can happen?

Answer 10

NO synthesis -> Vasodilation -> Cellular hypoxia -> Organ dysfunction/hypoperfusion -> Hypotension -> Death

Question 11

What is the normal SOFA score?

Answer 11

0

Question 12

In px with sepsis, what is the best test to determine effective and efficient blood flow around the body?

Answer 12

Capillary refill time = done in sternal area for 5 secs

Question 13

What is the most common risk factor of serious sepsis?

Answer 13

Age

Question 14

What are the core elements in managing sepsis and septic shock?

Answer 14

Resuscitation
Infection control
Respiratory support
General supportive care

Question 15

What resuscitation fluid is used for septic shock management?

Answer 15

IV crystalloid fluid (within 3h) => saline or balanced cyrstalloid is recommended

Question 16

What is the 1st choice vasoppressor in septic shock resuscitation?

Answer 16

Norepinephrine

Question 17

what is used for reducing norepinephrine dose?

Answer 17

Vasopressin

Question 18

What is given in septic shock resuscitation when px show persistent evidence of hypoerfusion despite adequate fluid loading & use of vasodepressors?

Answer 18

Dobutmine

Question 19

When do you give RBC transfusion in septic shock resuscitation?

Answer 19

Hgb <7.0g/dL
(-) AMI, severe hypoxemia or acute hemorrhage

Question 20

When do you assess and reassess fluid response during septic shock?

Answer 20

Take BP reading every hr

Question 21

What test is done to monitor changes in blood flow or pressure to predict fluid responsiveness?

Answer 21

Passive leg raise test

Question 22

What should u look out for during assessment of fluid responsiveness?

Answer 22

Spontaneou breathing
Cardiac arrhythmia
Low compliance/tidal volume <8mL/kg

Question 23

What are assessed in fluid responsiveness by dynamic parameters?

Answer 23

Stroke volume variation
Pulse pressure variation

Question 24

In severe cases of acute respiratry distress syndrome from sepsis/septic shock, what is a recommended maneuver?

Answer 24

Prone positioning

Question 25

What steroid is used in septic shock px when MAP is <65mmHg?

Answer 25

Hydrocortisone IV

Question 26

What is adrenal insufficiency that occurs in 20% of ICU px from sepsis?

Answer 26

Critical illness-related corticosteroid insufficiency

Question 27

What are the diff mobile genetic elements?

Answer 27

Plasmids = circles of DNA that move between cells
Transposons = small pieces of DNA that go into and change the overall DNA of a cell
Phages = carry DNA from germ to germ