Adult Sepsis Flashcards
define sepsis
- life-threatening organ dysfunction caused by a dysregulated host response to infection.
- aka: sepsis is a life-threatening condition that arise when the body’s response to an infection injures its own tissues and organs
Those more likely to be affected by sepsis
- extremes of age
- weakened immune system
- have wounds/injuries
- drug/ETOH abusers
- receiving IVs, wound drainage, urinary caths,
- chronically ill pts
- recent illness
- genetic factors
presentation of sepsis
- cool, pale extremities
- high/low temp (chills)
- lightheaded
- low BP, esp when standing
- rapid HR or palps
- low/absent UO
- decreased intake/appetites, esp in neonates
- altered mental status**
- SOB
- skin rash/discoloration
predispositions to sepsis
- trauma
- DM
- leukemia
- nursing home residents
- grannulocytopenia (splenectomy)
- GU extension (cath)
- pneumonia
- radiation
- longterm steroids
- immunosuppresive agents
- liver abscess
- F gyn
why do septic pts get hypovolemic?
- blood pools in microcirculation –> loss of intravascular space fluid
- d/t increased permeability: leaky capillary; fluid in wrong space
systemic sx of sepsis
- rigors
- fever (+/-)
- hypothermia
- petechiae
- leukocytosis
- leukopenia
- left shift CBC
localized sx of sepsis
- abdominal pain
- perirectal abscess
- penumonia, loculation, lung abscess
- occult: urinary, biliary, pelvis, retroperitoneal
toxic shock syndrome causative organism
staph
presentation of TSS
- usu w/i 5 days of period d/t tampon use (not as common any more)
- n/v/d, thrombocytopenia, rash
- blood cultures rarely positive
what differentiates sepsis from infection?
an aberrant or dysregulated host response and the presence of organ dysfunction
if unexplained organ dysfunction . . .
SUSPECT infection
purpose of qSOFA
initially evaluates for poor outcome in infected pts
criteria of qSOFA
- new/worsened altered mentation
- RR > 22
- systolic BP < 100
*each equals 1 pt if yes
qSOFA scoring: 2 or more
- a score of 2 or more: high risk of poor outcome - assess for organ dysfunction
- also calculate SOFA score
- pts should receive standard interventions for sepsis: flui resuscitation, abx, source control
qSOFA scoring: < 2
- does not immediately suggest that a pt is not at high risk
- if clinician is concerned, cont. w/ standard management of pts w/ suspected sepsis
adult SIRS criteria
- 2 or more of:
- temp > 38 or < 36
- HR > 90
- RR > 20 or PaCO2 < 32
- WBC > 12k or <4k or >10% immature bands
adult sepsis w/u
- CBC w/ diff
- blood cultures
- UA and culture
- CMP
- CXR
- Lactic acid level** serial to monitor
**if indicated: LP; amylase/lipase; sputum culture
LP is a diagnostic tool to r/o what?
- meningitis
- subarachnoid hemorrhage
LP is a therapeutic tool for what?
pseudo tumor cerebri
steps in a CSF lab analysis
- opening pressure
- orders written as follows according to tube collection sequence:
#1: cell count and differential
#2: protein and glucose
#3: gram stain and culture
#4: hold - note appearance of fluid - color and clarity
tx of sepsis
- fluids
- inotropes if fluids not working (pressors)
- IV abx - empiric initially then check sanford guide/sepsis handbook
- surg if specific location to remove
definition of septic shock
- subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality
- “a state of acute circulatory failure”
how to ID pts w/ septic shock
-clinical construct of sepsis w/ persisting hypotension requiring vasopressors to maintain MAP > 65mm Hg AND having serum lactate level > 2 mmol/L despite adequate volume resuscitation
hospital mortality rate when a pt is considered in septic shock
in excess of 40%
Grading level of hypotension in adult sepsis
- none: 0
- MAP < 70: 1
- on pressors, dopa < 5ug/kg/min or dobutamine: 2
- on dopa > 5ug/kg: 3
- on dopa > 15ug/kg: 4
grading level of renal function in adult sepsis
- Cr < 1.2: 0
- Cr 1.2-1.9: 1
- Cr 2.0-3.4: 2
- Cr 3.5-4.9: 3
- Cr > 5.0: 4
What is the new focus of the 2016 SOFA / qSOFA scoring?
- less on screening for a very strict definition of sepsis
- more on ID which pts w/ infections may have a poor outcome
