Adult Sepsis

Question 1

define sepsis

Answer 1

• 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

Question 2

Those more likely to be affected by sepsis

Answer 2

• 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

Question 3

presentation of sepsis

Answer 3

• 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

Question 4

predispositions to sepsis

Answer 4

• trauma
• DM
• leukemia
• nursing home residents
• grannulocytopenia (splenectomy)
• GU extension (cath)
• pneumonia
• radiation
• longterm steroids
• immunosuppresive agents
• liver abscess
• F gyn

Question 5

why do septic pts get hypovolemic?

Answer 5

• blood pools in microcirculation –> loss of intravascular space fluid
• d/t increased permeability: leaky capillary; fluid in wrong space

Question 6

systemic sx of sepsis

Answer 6

• rigors
• fever (+/-)
• hypothermia
• petechiae
• leukocytosis
• leukopenia
• left shift CBC

Question 7

localized sx of sepsis

Answer 7

• abdominal pain
• perirectal abscess
• penumonia, loculation, lung abscess
• occult: urinary, biliary, pelvis, retroperitoneal

Question 8

toxic shock syndrome causative organism

Answer 8

staph

Question 9

presentation of TSS

Answer 9

• 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

Question 10

what differentiates sepsis from infection?

Answer 10

an aberrant or dysregulated host response and the presence of organ dysfunction

Question 11

if unexplained organ dysfunction . . .

Answer 11

SUSPECT infection

Question 12

purpose of qSOFA

Answer 12

initially evaluates for poor outcome in infected pts

Question 13

criteria of qSOFA

Answer 13

• new/worsened altered mentation
• RR > 22
• systolic BP < 100

*each equals 1 pt if yes

Question 14

qSOFA scoring: 2 or more

Answer 14

• 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

Question 15

qSOFA scoring: < 2

Answer 15

• 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

Question 16

adult SIRS criteria

Answer 16

• 2 or more of:
• temp > 38 or < 36
• HR > 90
• RR > 20 or PaCO2 < 32
• WBC > 12k or <4k or >10% immature bands

Question 17

adult sepsis w/u

Answer 17

• CBC w/ diff
• blood cultures
• UA and culture
• CMP
• CXR
• Lactic acid level** serial to monitor

**if indicated: LP; amylase/lipase; sputum culture

Question 18

LP is a diagnostic tool to r/o what?

Answer 18

• meningitis

- subarachnoid hemorrhage

Question 19

LP is a therapeutic tool for what?

Answer 19

pseudo tumor cerebri

Question 20

steps in a CSF lab analysis

Answer 20

1. opening pressure
2. 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
3. note appearance of fluid - color and clarity

Question 21

tx of sepsis

Answer 21

• fluids
• inotropes if fluids not working (pressors)
• IV abx - empiric initially then check sanford guide/sepsis handbook
• surg if specific location to remove

Question 22

definition of septic shock

Answer 22

• subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality
• “a state of acute circulatory failure”

Question 23

how to ID pts w/ septic shock

Answer 23

-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

Question 24

hospital mortality rate when a pt is considered in septic shock

Answer 24

in excess of 40%

Question 25

Grading level of hypotension in adult sepsis

Answer 25

• none: 0
• MAP < 70: 1
• on pressors, dopa < 5ug/kg/min or dobutamine: 2
• on dopa > 5ug/kg: 3
• on dopa > 15ug/kg: 4

Question 26

grading level of renal function in adult sepsis

Answer 26

• 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

Question 27

What is the new focus of the 2016 SOFA / qSOFA scoring?

Answer 27

• less on screening for a very strict definition of sepsis

- more on ID which pts w/ infections may have a poor outcome