deck_5338520

Question 1

What is sepsis?

Answer 1

systemic inflammatory response syndrome (SIRS) due to known or suspected infectionNOT a positive blood culture (aka bacteremia)

Question 2

Can sepsis occur without dissemination?

Answer 2

Yes

Question 3

T or F. Bacteremia can be tranisent

Answer 3

T. Even is normal conditions (i.e. straining to go No. 2) you can get some

Question 4

How common is sepsis?

Answer 4

leading cause of death in critically ill patients (210,000 deaths/year)

Question 5

Patient population for sepsis?

Answer 5

Nonwhite persons, and men (because androgens are more pro-inflammatory than estrogens)

Question 6

What group of bacteria are the most common cause of sepsis?

Answer 6

gram +

Question 7

T or F. Early mobilization is good even in sepsis

Answer 7

T.

Question 8

Trends with sepsis

Answer 8

-fungal causes on the rise-in-hospital mortality and length of hospital stay falling

Question 9

What is ‘severe’ sepsis defined as?

Answer 9

sepsis + organ failure

Question 10

What is ‘septic shock’ defined as?

Answer 10

severe sepsis plus refractory hypotension which persists despite giving 30cc/kg of fluid and require vasopressors

Question 11

How is sepsis defined?

Answer 11

life-threatening organ dysfunction cause by a dysregulated host response to infection

Question 12

What NON-infectious etiologies can cause SIRS?

Answer 12

-pancreatitis-burns-trauma -organ rejection

Question 13

How is SIRS defined? criteria

Answer 13

two or more of:1. Temp over 38C or under 36C2. Heart rate 90+ bpm3. Tachypnea, RR over 204. WBC over 12k or less than 4k (OR 10+%bands)

Question 14

What are some noninfectious causes of SIRS?

Answer 14

-blood transfusion-surgery-many others

Question 15

T or F. Many patients with sepsis do not become febrile

Answer 15

T.

Question 16

What are some patient populations that can have afebrile SIRS?

Answer 16

-extreme age-immunocompromised -corticosteroids -NAIDS/acteaminophen use -CKD (especially on dialysis)-Diabetes uncontrolled -Strokes/brain malfunction (hypothalamus damage)need an immune response!

Question 17

What is the purpose of fever?

Answer 17

enhances immune system ability to handle infection (phagocytosis, Ab binding is more optimal)

Question 18

Sepsis = what?

Answer 18

SIRS + infection

Question 19

What causes hypotension in septic shock?

Answer 19

vasodilation and increased permeability

Question 20

What kind of shock is septic shock?

Answer 20

distributive

Question 21

Ex. of obstructive shock

Answer 21

pulmonary embolism

Question 22

Why would you see tachycardia in SIRS?

Answer 22

reflex of hypotension

Question 23

T or F. Sepsis can be associated with mental status change

Answer 23

T. Poor prognosis

Question 24

Vomiting is one of the very first signs of infection in which patients?

Answer 24

kids

Question 25

In the ICU, another manifestation of sepsis is not tolerating feed well. How does this manifest?

Answer 25

Gastric residuals- this is a quantifier that can be measured by a nurse and if the food is going where it should be, this should be very low

Question 26

What is the ‘silver day’ of sepsis?

Answer 26

notion that early treatment makes for the best prognosis

Question 27

What are some of the goals of fluid directed treatment of sepsis?

Answer 27

-central venous pressure of 8-12 mm Hg-MAP greater than 65 mm Hg-Urine output more than 0.5ml/kg/hr-central venous O2 saturation over 70%

Question 28

What is a normal SvO2?

Answer 28

65-70% and decreased when oxygen delivery is inadequate

Question 29

SvO2 can be corrected in sepsis by doing what?

Answer 29

optimizing Hb and/or CO

Question 30

What is another way to test whether oxygen is being delivered as intended?

Answer 30

lactic acid measurement

Question 31

Each hour delay in ABX increases mortality by ____%

Answer 31

6-7

Question 32

What kinds of lab work is needed before starting ABX in sepsis?

Answer 32

-2 sets of blood culture -CBC-CXR, CT scan

Question 33

What are two ABX known to decrease toxin production?

Answer 33

Clindamycin and Linezolid

Question 34

What fluids are used in sepsis?

Answer 34

Normal saline (albumin will work the same but way more expensive) or a crystalite

Question 35

Why is called ‘normal’ saline?

Answer 35

it is isotonic

Question 36

What is the pH of normal saline?

Answer 36

5.4, so more equals a higher risk of hyperchloremia and metabolic acidosis

Question 37

AEs of normal saline?

Answer 37

-alterations in renal blood flow-effect immune functionbalanced fluids avoid these biochemical effects

Question 38

Balanced fluids (sodium acetate/Lactoringer’s provides a better response for sepsis. How?

Answer 38

Balancing pH as well as being isotonic

Question 39

Why cant you just use Lactoringer’s saline?

Answer 39

potassium levels may start to increase

Question 40

What are some choices of vasopressor?

Answer 40

-Levophed better than Dopamine at 20mics/min of Levophed, add vasopressin

Question 41

Preventive measures in sepsis

Answer 41

-hand washing-DVT prophylaxis-stress ulcer prophylaxis -head of the bed elevation-chlorhexidine mouthwash -remove foley cath and central lines ASAP-early ambulation-target glucose less than 150 mg/dL

Question 42

Why do septic patients have hyperglycemia?

Answer 42

increased catecholamines cause increased gluconeogenesis and insulin resistance

Question 43

Autopsy/Immunohistochemical studies of sepsis have shown which cell lines to be dying?

Answer 43

lymphocytes and GI epithelial cells