8 - Sepsis Flashcards

1
Q

Common and less common causes of sepsis?

A

Most Common:
- gram +/- bacteria

Still possible:

  • fungi
  • virus
  • mycobacteria
  • rickettsia
  • protozoans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Sepsis is a …

A

Heterogenous syndrome characterized by widespread inflammation and potential organ harm initiated by a microorganism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mortality rate for sepsis?

A

20% in normal patients

50% with sick patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Stages of sepsis?

A

Sepsis: infection with systemic inflammation

“Severe sepsis”: sepsis + new organ dysfunction (hypoperfusion)
- (severe sepsis is no longer a term)

Septic shock: cardiovascular failure

  • elevated serum lactate
  • hypotension
  • need vasopressin despite fluid resuscitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SIRS criteria

A

Systemic inflammation response syndrome

  1. Fever or hypothermia
  2. Pulse rate >90 or 2SD above
  3. Tachypenia >20 breaths per min
  4. WBC count
    - Leukocytosis WBC >1200 or
    - leukopenia WBC <400
    - normal w >10% immature forms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

qSOFA tool

A

Quick sequential organ failure assessment

OUTCOMES TOOL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

qSOFA tool criteria

A

Altered mental
Respiratory >/= 22
Systolic BP = 100

Score >2 indicates high risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

qSOFA tool requires?

A

Requires validation, it replaces judgment about potential/actual infection and requires greater than one system involvement

  • this is sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

SIRS criteria does not?

A

Confirm the presence of infection or sepsis. Can be many other things like trauma, pancreatitis or burns

But it is a good indicator of morbidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is lactate related to sepsis?

A

Serum lactate across a wide spectrum provides excellent prognosis data in those with sepsis but is not diagnostic alone

As lactate goes up so does mortality

Those pts that cant clear lactate die more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pathophysiology for sepsis?

A

Host immune response fails to control and/or overreacts to invasive pathogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

2 critical events that sepsis overreaction causes?

A
  1. Marked abnormalities in inflammatory response in the host
    - 1st hyper then hypo inflammatory response
  2. Imbalance in procoagulant and anticoagulant functioning -> DIC
    - DIC -> micro and macro vascular clot formation, impaired microvascular tissue perfusion and thrombosis of small vessels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical presentation for sepsis?

A

Vital signs
- fever, HOTN, tachycardia

DIC
- warm periphery w increased CO

Lungs

  • Decreased pulmonary function
  • ARDS (new lung edema)
  • Refractory hypoxemia

Kidney
- azotemia, oliguria, anuria

Hepatic:

  • cholestatic jaundice (MC)
  • H transaminase, alkphos, bilirubin

GI:

  • ileus (MC)
  • blood loss (painless erosions in mucosal layer)

Heme
- thrombocytopenia

Metabolic changes
- hyperglycemia, hypoglycemia

Cutaneous
- 5 manifestations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cutaneous manifestations of sepsis?

A
  1. Direct bacterial;
    - cellulitis, fasciitis
  2. Hematogenous seeding of the skin;
    - petechiae, pustules, cellulitis
  3. Lesions from HOTN or DIC;
    - acrocyanosis and necrosis
  4. Lesions from IV infection;
    - micro-emboli, immune complex
  5. Lesions caused by toxins
    - toxic shock syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do children respond differently to Sepsis?

A

They dont have hypotension until late b/c they can up regulate their heart rate as a compensatory response to tissue hypoperfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Common tests for Sepsis?

A
  • CBC w paltelet
  • Serum electrolytes (ca and glucose)
  • Renal function panel
  • Lactic acid level
  • Liver function panel
  • UA
  • ABG
  • type and screening of RBCs
  • coag and PTT w bleed
  • fibrinogen
  • D-dimer
17
Q

Radiology for sepsis?

A
CXR - (pneumonia)
CT
- Abdominal 
- Soft tissue - free air/abscess
- Head - meningitis
- LP
18
Q

Cultures for sepsis?

A

Min 2 sets of blood cultures

Gram stain and culture of any potential infections

CRP, Procalcitonin - systemic inflammation

19
Q

Cornerstone of tx for sepsis?

A
  • Early recognition
  • Early reversal of hemodynamic compromise
  • Early infection control
20
Q

Goals of resuscitation?

A

Improve

  • preload
  • Tissue perfusion
  • O2 deliver
21
Q

What is the set amount of fluid for sepsis?

A

No set amount

Typically total bolus of 2-5L of crystalloid in first 6hrs

22
Q

Vasopression and sepsis

A

Dont delay vasopression when BP doesnt respond to volume overload seems likely

23
Q

Elements that improve sepsis?

A

Early recognition
Abx
Adequate volume resuscitation
Adequate circulation

24
Q

How to administer fluids

A

Replenish circulating volume - approx 20-30mg/kg crystalloid bolus

25
Q

DOC for vasoconstriction?

A

Norepinephrine 0.5-30 micrograms/min

Can use epinephrine but the risk of med error is higher

26
Q

How long to get abx onboard?

A

ASAP

W/in 1 hr of recognition
W/in 3 hrs of triage

27
Q

Definition of septic shock?

A

Need for vaso pressor (after 2 L of fluid)

Elevated lactate

Infection source

28
Q

Hartman: [quietly and strictly] Now, you listen to me, Private Pyle, and you listen good. I want that weapon. And I want it now. You will place that rifle on the deck at your feet… and step back away from it.

A

Hartman: [angrily bellowing] WHAT IS YOUR MAJOR MALFUNCTION, NUMBNUTS?! DIDN’T MOMMY AND DADDY SHOW YOU ENOUGH ATTENTION WHEN YOU WERE A CHILD?!

[Pyle shoots him in the heart, killing him instantly, then aims at Joker.]