28/29 - Adult - Sepsis and Sepsis TPs

Question 1

when hypotension is not
responsive to fluid resuscitation, requiring vasopressors and clinical
evidence indicates inadequate perfusion of major organ systems, with progressive failure of organ system function

A. Sepsis
B. Severe Sepsis
C. Septic shock

Answer 1

C. Septic shock

Question 2

Evidence of end‐organ dysfunction, such
as hypotension (systolic blood pressure < 90)
mmHg), jaundice, hypoxia, elevated lactate or petechiae

A. Sepsis
B. Severe Sepsis
C. Septic shock

Answer 2

B. Severe Sepsis

Question 3

Infection that is documented or suspected, along with the
SIRS (See Sepsis Criteria) criteria and/or altered mental status.

A. Sepsis
B. Severe Sepsis
C. Septic shock

Answer 3

A. Sepsis

Question 4

A “Code Sepsis” is called when 2+ of the Sepsis Criteria are present. What are the sepsis criteria?

Answer 4

1. Temp ≥ 100.4°F or ≤ 96.8 °F
2. Blood Pressure ≤ 90mmHg or MAP≤ 65mmHg
3. Heart Rate ≥ 90 BPM
4. Respiratory Rate ≥ 20 BPM
5. ETCO2 reading of ≤ 35mmHg
6. History of present/past infection
7. Serum Lactate ≥ 4 mmol/L (if available)

Question 5

Calculate MAP

Answer 5

MAP = SBP + (2xDBP)/3

*The heart spends 2/3 of the cardiac cycle in diastole

Question 6

NS bolus for suspected sepsis patients.

A. 20 mL/kg NS
B. 30 mL/kg NS
C. 40 mL/kg NS
D. 50 mL/kg NS

Answer 6

B. 30 mL/kg NS*

*Yes, this is the correct answer. Normal fluid replacement is 20 mL/kg, but in sepsis, early, aggressive fluid resuscitation is important.

Question 7

If a suspected adult sepsis patient maintains an SBP under 100 or an MAP of under 65 after a NS bolus, what is the next step?

Answer 7

5 mcg/kg/min of dopamine, increased by 5 mcg/kg/min q2min to a max dose of 20 mcg/kg/min and SBP under 100 mmHg