EXAM #1: SEPSIS

Question 1

What is the definition of SIRS?

Answer 1

Systemic Inflammatory Response Syndrome characterized by 2+ of the following:

1) Temperature greater than 38 C (101.4F) or less than 36 C (96.8)
2) HR greater than 90
3) RR greater than 20 or PaCO2 less than 32
4) WBC greater than 12K or less than 4,000K

Question 2

What is sepsis?

Answer 2

SIRS + identified infection

Question 3

What is severe sepsis?

Answer 3

Sepsis with evidence of organ dysfunction evidenced by:

1) SBP less than 90 or 70 MAP
2) Elevated Lactate
3) UOP less than 0.5mg/kg/hr
4) ALI with PaO2/FiO2 less than 250
5) Bilirubin greater than 4.0
6) Creatinine greater than 2.0
7) Platelets less than 100,000

Question 4

What is septic shock?

Answer 4

Sepsis and hypotension DESPITE adequate fluid resuscitation

Question 5

What type of shock is seen in sepsis?

Answer 5

Distributive shock

Question 6

What is the cascade of pathophysiological events that occurs in sepsis?

Answer 6

1) Distributive shock
2) Mycocardial depression
3) Bone marrow suppression
4) Activation of the clotting cascade (DIC)
5) Organ dysfunction

Question 7

What are the most common causes of sepsis?

Answer 7

UTI and pneumonia

Question 8

What labs should be ordered for the patient with sepsis?

Answer 8

1) CBC (lymphocytes, anemia, DIC)
2) Creatinine
3) Bicarbonate (metabolic acidosis)
4) Lactate (hypoperfusion)
5) Glucose
6) LFT
7) PT, PTT, INR
8) ABG

Question 9

In regards to antibiotics, what do you need to do first?

Answer 9

Blood cultures

Question 10

What has been shown to improve mortality in sepsis?

Answer 10

Early antibiotics i.e. within 1 hour of arrival to the hospital

Question 11

What is the APACHE score used to determine?

Answer 11

• Severity of sepsis

- Aggressiveness of treatment

Question 12

Summarize the goals sepsis therapy as determined by the 2001 review.

Answer 12

1) MAP of 65 mmHg or greater
2) Initial fluid challenge of 30 mL/Kg
3) NE first line for sepsis refractory to initial fluid challenge
4) Early initiation of antibiotic therapy (1 hour)
- Broad and then de-escalate

*Central line is not absolutely necessary

Question 13

What is more efficacious, monotherapy vs. combination therapy?

Answer 13

Combination therapy

Question 14

What are the markers you follow to see how a septic patient is responding to your therapy?

Answer 14

1) MAP

2) Lactate