Approach to Sepsis

Question 1

What, generally, is the relative sensitivity and specificity of SIRS criteria for sepsis?

Answer 1

Poor

Question 2

What are the four components of the SIRS criteria?

Answer 2

1. temp not 36-38
2. tachy (90+)
3. 20 breaths per min (PaCO2 less than 32)
4. WBCs not 4-12

Question 3

What is severe sepsis?

Answer 3

Sepsis + organ dysfunction

Question 4

A lactate over what value is suggestive of severe sepsis?

Answer 4

2 mmol/L

Question 5

What is the definition of septic shock?

Answer 5

Sepsis + shock despite 30 mL/kg of IVFs

Question 6

What is the lab that is used to risk stratify patients with sepsis?

Answer 6

Lactate

Question 7

When is a third blood culture indicated in the workup of sepsis?

Answer 7

If suspecting endocarditis

Question 8

True or false: reductions in lactate in sepsis pts correlate with reduced mortality

Answer 8

True

Question 9

What are the labs that are obtained when trying to assess for end organ damage in sepsis?

Answer 9

• PT/INR
• Platelets
• Cr
• Bili

Question 10

What value of the following labs suggest end organ damage in sepsis:

• PT/INR
• Platelets
• Cr
• Bili

Answer 10

• PT/INR = more than 1.5
• Platelets = less than 100,000
• Cr more than 2
• Bili = more than 2

Question 11

a SBP drop of what amount from baseline indicates hypotension?

Answer 11

40 mmHg

Question 12

What is the effect of waiting to give ABX in sepsis pts?

Answer 12

Waiting does not appear to increase mortality (for up to 6 hours)

Question 13

What generally involves early goal directed therapy in sepsis?

Answer 13

Placement of a central line, art line, and getting CVP at 8-12 range quickly

Question 14

What is the goal change in lactate level with sepsis?

Answer 14

Reduction of 10% quickly

Question 15

Why is it important to test fresh blood for lactate levels?

Answer 15

If older, then RBCs will produce lactate and falsely elevate the level