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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
Q

What are rare classifications of shock

A

Anaphylactic
Neurogenic
Toxic

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26
Q

What are the stages of shock

A

Non-progressive
Progressive
Irreversible

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27
Q

What defines non progressive shick

A

Compensatory mechanisms allow for survival

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28
Q

What defines Progressive shock

A

Failing compensatory mechanisms
Increasing tissue hypoxia
Beginning lactic acidosis due to tissue anaerobic metabolism

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29
Q

In shock what happens to the peripheral vasculature

A

vasoconstriction due to autonomic nervous system stimulus and adrenal catecholamines

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30
Q

What is shunting

A

redistribution of blood to heart and brain

31
Q

Shock causes a decrease in what organ functions

A

liver and kidney

32
Q

What happens to the blood in shock

A

Hemodilution and hypovolemia

33
Q

what causes hemodilution and hypovolemia

A

Interstitial fluids move into the vascular space to replace volume lost

34
Q

What is rubor

A

redness

35
Q

what is calor

A

heat

36
Q

what is tumor

A

swelling

37
Q

what is dolor

A

pain

38
Q

what is functio laesa

A

loss of function

39
Q

What does VINDICATE stand for

A 
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
Q

What is a narrow spectrum drug

A

Effective against a few species/classes of pathogens

41
Q

What is broad a spectrum drug

A

Effective against many species/classes of pathogens

42
Q

What is the advantage of narrow spectrum

A

Specificity

43
Q

What is the advantage of broad spectrum

A

Maximize probability of toxicity to pathogens

44
Q

what is combination chemotherapy

A

use of multiple drugs against the same pathogen

45
Q

What are indications for the use of combination chemotherapy

A
  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
Q

Defined chemotherapy

A

pathogen identified, drug choice informed by susceptibility tests

47
Q

empiric chemotherapy

A

pathogen not identified

48
Q

what is leukocytosis

A

high WBCs

49
Q

What is thrombocytosis

A

high platelets

50
Q

what is high lactate indicative of

A

hypoperfusion

51
Q

What is the significance of air in subcutaneous tissue

A

indication of infection causing associated tissue destruction

52
Q

what is thrombocytopenia

A

low platelets

53
Q

What is DIC

A

Disseminated Intravascular Coagulation

54
Q

what lab value denotes DIC

A

low fibrinogen, its being consumed

55
Q

What are ways to treat BP in sepsis

A

IV fluids
Vasopressors - improve by causing vasoconstriction
Inotropes - increase cardiac contractility

56
Q

Sepsis therapies

A

Ventilatory support with oxygen
Dialysis
Corticosteroids for adrenal failure
nutrition

57
Q

What are the general mechanisms of sepsis

A

host becomes infected
bacteremia
endotoxins released by microbe
procession depends on host

58
Q

What is the typical host response to infection

A

host recognizes microbial molecules
Production of cytokines, chemokines, prostaglandins, LTs
Rubor, tumor, calor, dolor

59
Q

what are cytokines

A

soluble proteins that interact with cells to produce changes in growth/activation of immune cells, inflammation and immune response

60
Q

what are chemokines

A

soluble molecules which guide immune cells into a particular area

61
Q

what is TNF alpha

A

a cytokine

62
Q

what does TNF alpha do

A

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
Q

what do IL-8 and IL-7 do

A

attract neutrophils

64
Q

what does IL-1 beta do

A

cause fever

65
Q

what does intravascular thrombosis do

A

key factor in local inflammation

walls off microbes, intravascular fibrin deposition

66
Q

IL-6 promotes what

A

clotting via TF induction on monocytes and vascular endothelial cells

67
Q

what is DIC

A

consumption coagulopathy or microangiopathic hemolytic anemia

68
Q

what does DIC consume

A

platelets and clotting factors

69
Q

aquired DIC is a serious sign of what

A

end stage sepsis

70
Q

what is waterhouse friderichsen syndrome

A

adrenal gland failure as a result of hemorrhage into the glands

71
Q

what is a needed therapy for adrenal glad failure

A

adrenocorticoid therapy

72
Q

what is a nutmeg liver indicative of

A

vascular congestion

73
Q

what is shock liver indicative of

A

passive congestion

Test 1 IBI (8 decks)

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