12.5 B Flashcards
The baseline mortality rate in the US for sepsis is what?
30-50 percent
How many cases of sepsis are there each year in the US?
approximately 2 million
How does a case of sepsis affect your long term health?
it puts you at greater risk of dying from stroke or MI and a number of other disease
What trend has been seen in the incidence of sepsis over the last three decades?
population adjusted increase in incidence
Which generation is sepsis most prevalent in?
baby boomers
How many capillaries are there in the human body?
30-40 billion
How many miles of blood vessels are there in the human body?
60,00 miles
The biggest affect of sepsis on microcirculation is what?
that RBCs fail to deform in capillaries, limiting surface area for nutrient exchange and potentially clogging up the vessels
Failure of RBCs to deform in sepsis causes what issues?
- clogs vessels
- limits nutrient exchange
- limits blood flow to tissue and triggers a switch to anaerobic metabolism
What are the criteria for SIRS?
two or more of the following: abnormal temperature, tachycardia, tachypnea, elevated white cell count
What are the criteria for sepsis?
SIRS + an infection
What are the criteria for severe sepsis?
sepsis + organ dysfunction
What are the criteria for septic shock?
sepsis + hypotension despite fluid resuscitation
What are some indicators of organ dysfunction that might be seen in someone with severe sepsis?
- confusion/altered consciousness
- tachypnea
- hypotension
- oliguria, anuria, elevated creatine
- elevated bilirubin
- low platelet count
What is procalcitonin?
a possible biomarker, not for diagnosis of sepsis but useful for follow up
The most important thing about treating sepsis is what?
that it is done quickly
What are the characteristics of “bundles of care?”
- combine multiple effective treatments
- outcome is additive or synergistic
- framework that leverages change
- avoids a piecemeal approach
What should be done in the first three hours to treat sepsis?
- measure serum lactate
- obtain blood cultures
- administer broad spectrum antibiotics
- administer a 30mL/Kg bolus of fluid if hypotensive or has elevated lactate
What should be done in the first six hours to treat sepsis?
- basically control blood pressure
- vasopressors if not responding to fluid
- measure cnetral venous pressure and central venous oxygen saturation
- remeasure lactate if initially elevated
In the early resuscitation of severe sepsis, the most important treatment is what?
the administration of antibiotics
