Sepsis

Question 1

Define:
1. Sepsis
2. Bacteremia
3. Septic shock
4. Systemic inflammatory response (SIRS)

Answer 1

1. Systemic inflammatory response to infection or bacterial toxins
2. Bacteria in the blood stream
3. Hypotension secondary to severe sepsis
4. Organ failure or immune system collapse due to septic shock

Question 2

Sepsis types clinical signs
1. Hyperdynamic (3)
2. Hypodynamic (3)

Answer 2

1. Hyperdynamic
   - Brick red MM
   - Tachycardia
   - Bounding pulse
2. Hypodynamic
   - Hypotension
   - Pale MM
   - Hypothermia

Question 3

Sepsis Care
Step 1: Characterize patient condition & begin instrumentation (5)

Answer 3

1. Monitor with ECG, pulse ox
2. Large-bore peripheral catheter
3. Central venous catheter
4. Collect blood:
   - CBC, Chem, Big 4, Arterial BG, COAG
5. If SpO2 <90% or increase resp effort present: O2 by face mask!

Question 4

Sepsis care Goals (9) (name 4/9)

Answer 4

Normal, stable vitals! (TPR)
1. Stable O2
2. Stable perfusion (BP)
3. Stable hydration
4. Stable electrolytes, pH, glucose
5. Tx primary cause
6. Stable organ function
7. COMFORT (clean/dry, pain, nausea control)
8. Stable clotting status
9. Nutritional support

Question 5

Sepsis care goals: Canine (

Question 6

Sepsis care
Step 2: Identify hypoglycemia, K or Ca++ disorders and eval response to fluid exchange (4)

Answer 6

1. Run glucose test immediately
2. Eval BG / electrolyte status
3. Insert cont temp probe & begin active warming w warm air unit until temp WNL or signs Pt is trying to warm itself
4. Eval HR, RR, MM color, CRT, pulse, CVP, & ABP

Question 7

Sepsis care
Step 3: Oxygen, metabolic monitoring, identifying source of infection (6)

Answer 7

1. Collection of samples for cytology & cult
2. No source apparent, obtain urine, thoracic rads, abdominal ultra
3. Aspirate any abdominal fluid or perform transtracheal airway wash based on findings
4. Blood cultures if primary source not identified
   - See ICU blood cult protocol
5. Nasal O2: Insert a nasal cannula for cont nasal O2 administration
6. Indwelling urinary catheter in obtunded patients

Question 8

Sepsis care
Step 4: Source control (1)
Step 5: Supporting homeostasis (2)

Answer 8

1. Antibiotics: Begin as soon as culture samples are collected
2. Maintain hematocrit if Pt has difficulty compensating anemia
   - Maintain total solids/oncotic pressure

Question 9

Sepsis care steps
Step 1
Step 2
Step 3
Step 4
Step 5

Answer 9

1. Characterize patient condition & begin instrumentation
2. Identify hypoglycemia, K or Ca++ disorders and eval response to fluid exchange
3. Oxygen, metabolic monitoring, identifying source of infection
4. Source control
5. Supporting homeostasis

Question 10

Sepsis care:
Coagulation (3)

Answer 10

1. Evaluation of coag status
   - Pt/PTT, platelets, fibrinogen, FDP
2. Heparin therapy
3. Fresh frozen plasma

Question 11

Sepsis care
1. Analgesia
2. Patient positioning (2)
3. GI protection (2)

Answer 11

1. Use multimodal therapy whenever possible. Avoid NSAIDs until hemodynamically stable & risk of GI injury diminishes.
2. Head elevated, sternal or semi-sternal is best to limit risk of aspiration & improve pulmonary gas exchange.
   - Institute a plan for positioning changes, PROM therapy.
3. Medication, Drip feeding

Question 12

Sepsis care
Nutrition (3)

Answer 12

1. Hand feeding
2. Feeding tubes
3. Parenteral nutrition