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Test 1 IBI > B3.002 - Sepsis > Flashcards

B3.002 - Sepsis Flashcards

1
Q

What is the older accepted progression of sepsis

A

SIRS –> Sepsis –> Severe Sepsis –> Septic Shock

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2
Q

SIRS criteria

A

At least 2 of the 4 of the following:

  1. Fever or hypothermia
  2. Tachycardia
  3. Tachypnea
  4. Leukocytosis
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3
Q

What is happening in SIRS

A

Cytokine storm which can cause multiple organ dysfunction

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4
Q

What are the criteria for Sepsis

A

The same as SIRS plus suspected or proven infection

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5
Q

What are the criteria for severe sepsis

A

Same as SIRS and Sepsis plus end organ dysfunction in one or more organ systems

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6
Q

What are the criteria for refractory septic shock

A

All of the above plus lasts for 1 hour despite fluid resuscitation and pressors, may lead to death

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7
Q

What is the continuum now widely accepted of sepsis syndromes

A

Early sepsis –> Sepsis –> Septic Shock

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8
Q

What is early sepsis

A 
Infection based on clinical suspicion 
qSOFA score
* RR >22
* Altered mentation
*Systolic BP <100 mmHg
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9
Q

What is a qSOFA score of <2 indicative of

A

a 3% risk of mortality

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10
Q

What is a qSOFA score of >2 indicative of

A

associated with poor outcomes and 18-24% mortality

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11
Q

What is considered Sepsis

A

Life-threatening organ dysfunction caused by an infection with dysregulated host response
Infection
SOFA score
* increase of 2 or more points

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12
Q

What constitutes septic shock

A

Vasodilation or distribution problem due to sepsis
Associated with greater risk of mortality
Sepsis
Requirement of vasopressors to maintain a mean arterial pressure of >65
Lactate over 2
>40% mortality vs >10% with sepsis alone

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13
Q

Define shock

A

Diminished cardiac output or reduced effective circulating blood volume impairs tissue perfusion and leads to cellular hypoxia

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14
Q

What causes shock

A

Infection
Anaphylaxis
Cardiac abnormality
hypovolemia

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15
Q

What can septic shock progress to

A

Multiple organ dysfunction syndrome

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16
Q

What is multiple organ dysfunction syndrome

A

Primary - result of a defined insult
Secondary - result of an indirect insult due to hosts response
No universally accepted criteria - use the SOFA score

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17
Q

Why is sepsis frequency increasing

A

More aggressive surgery
More resistant organisms
More immune compromise from disease/meds
Increased elderly living with chronic disease
Widespread use of catheters/mechanical devices

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18
Q

Whats the 28 day mortality of septic shock

A

40-70%

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19
Q

What indicates a poor prognosis for sepsis patients

A 
Increased age
Comorbid medical conditions
High APACHE II score
Elevated lactate
Insufficient response to vasopressors
Delay in treatment
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20
Q

What are infectious causes of sepsis

A

Opportunistic infections
Host factors
Indwelling lines/catheters
Microbial factors

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21
Q

Infections that can cause sepsis

A 
Pneumonia 
Peritonitis
Pyelonephritis
Absecces 
Bacteremia
Chilangitis
Cellulitis and necrotizing fascitits
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22
Q

What is shock

A

Sudden drop in cardiac perfusion or reduced circulating volume

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23
Q

What can shock lead to

A

Tissue hypoperfusion and hypoxia

Cell necrosis and eventually organ failure and death if not corrected

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24
Q

What are common classifications of shock

A

Cardiogenic
Hypovolemic
Septic

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25
What are rare classifications of shock
Anaphylactic Neurogenic Toxic
26
What are the stages of shock
Non-progressive Progressive Irreversible
27
What defines non progressive shick
Compensatory mechanisms allow for survival
28
What defines Progressive shock
Failing compensatory mechanisms Increasing tissue hypoxia Beginning lactic acidosis due to tissue anaerobic metabolism
29
In shock what happens to the peripheral vasculature
vasoconstriction due to autonomic nervous system stimulus and adrenal catecholamines
30
What is shunting
redistribution of blood to heart and brain
31
Shock causes a decrease in what organ functions
liver and kidney
32
What happens to the blood in shock
Hemodilution and hypovolemia
33
what causes hemodilution and hypovolemia
Interstitial fluids move into the vascular space to replace volume lost
34
What is rubor
redness
35
what is calor
heat
36
what is tumor
swelling
37
what is dolor
pain
38
what is functio laesa
loss of function
39
What does VINDICATE stand for
``` Its for differential Dx of sepsis V - Vascular I - Infectious N - Neoplasm D - Drugs/toxins I - Inflammatory C - Congenital/genetic A - Autoimmune T - Trauma E - Endocrine/metabolic ```
40
What is a narrow spectrum drug
Effective against a few species/classes of pathogens
41
What is broad a spectrum drug
Effective against many species/classes of pathogens
42
What is the advantage of narrow spectrum
Specificity
43
What is the advantage of broad spectrum
Maximize probability of toxicity to pathogens
44
what is combination chemotherapy
use of multiple drugs against the same pathogen
45
What are indications for the use of combination chemotherapy
1. enhanced therapeutic effect 2. Allow use of lower doses of individual drugs 3. delay development of resistance 4. Treatment of mixed infections 5. Initiate therapy in life threatening situations where pathogen isnt known
46
Defined chemotherapy
pathogen identified, drug choice informed by susceptibility tests
47
empiric chemotherapy
pathogen not identified
48
what is leukocytosis
high WBCs
49
What is thrombocytosis
high platelets
50
what is high lactate indicative of
hypoperfusion
51
What is the significance of air in subcutaneous tissue
indication of infection causing associated tissue destruction
52
what is thrombocytopenia
low platelets
53
What is DIC
Disseminated Intravascular Coagulation
54
what lab value denotes DIC
low fibrinogen, its being consumed
55
What are ways to treat BP in sepsis
IV fluids Vasopressors - improve by causing vasoconstriction Inotropes - increase cardiac contractility
56
Sepsis therapies
Ventilatory support with oxygen Dialysis Corticosteroids for adrenal failure nutrition
57
What are the general mechanisms of sepsis
host becomes infected bacteremia endotoxins released by microbe procession depends on host
58
What is the typical host response to infection
host recognizes microbial molecules Production of cytokines, chemokines, prostaglandins, LTs Rubor, tumor, calor, dolor
59
what are cytokines
soluble proteins that interact with cells to produce changes in growth/activation of immune cells, inflammation and immune response
60
what are chemokines
soluble molecules which guide immune cells into a particular area
61
what is TNF alpha
a cytokine
62
what does TNF alpha do
causes leukocytes and vascular endothelial cells to 1. produce and release more cytokines 2. express cell surface molecules to improve adhesion to neutrophils 3. increase inflammatory production of prostaglandins and LTs
63
what do IL-8 and IL-7 do
attract neutrophils
64
what does IL-1 beta do
cause fever
65
what does intravascular thrombosis do
key factor in local inflammation | walls off microbes, intravascular fibrin deposition
66
IL-6 promotes what
clotting via TF induction on monocytes and vascular endothelial cells
67
what is DIC
consumption coagulopathy or microangiopathic hemolytic anemia
68
what does DIC consume
platelets and clotting factors
69
aquired DIC is a serious sign of what
end stage sepsis
70
what is waterhouse friderichsen syndrome
adrenal gland failure as a result of hemorrhage into the glands
71
what is a needed therapy for adrenal glad failure
adrenocorticoid therapy
72
what is a nutmeg liver indicative of
vascular congestion
73
what is shock liver indicative of
passive congestion

Test 1 IBI (8 decks)

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