Exam 4 Sepsis

Question 1

Definition of severe sepsis

Answer 1

Acute organ dysfunction secondary to infection

Question 2

Septic shock definition

Answer 2

Severe sepsis with hypotension NOT reversed by fluid administration

Question 3

S/S of infection:

Answer 3

fever
AMS
encephalopathy

Question 4

S/S of septic shock:

Answer 4

hemodynamic instability that accompanies sepsis and perfusion abnormalities including:

• lactic acidosis
• oliguria
• change in mental status

Question 5

characteristics of high-output cardiac failure and distributive shock as seen in septic shock:

Answer 5

• hypotension
• bounding pulses
• wide pulse pressure

Question 6

Sepsis definition

Answer 6

umbrella term for conditions where there are pathogenic microorganisms in the body

Question 7

SIRS definition

Answer 7

similar response to sepsis but occurs in the absence of infection

Question 8

SIRS Criteria: Temp, HR, RR, WBC

Answer 8

Temp: >100.4ºF or <96.8ºF
HR: Tachycardia (> 90 bpm)
RR: Tachypnea (>20 bpm)
WBC: >12K or <4K

Question 9

Sepsis criteria

Answer 9

2+ SIRS
Presumed/documented infectious focus

(CT +PNA, infected fluid. UA+, BC+, cellulitis, etc.)

Question 10

Severe sepsis criteria

Answer 10

2+ SIRS
Source of infection
Acute organ dysfunction

Question 11

Septic shock

Answer 11

2+ SIRS
Source of infection
Acute organ dysfunction
Persistent hypotension despite fluid resuscitation

Question 12

Sepsis mangement goals:

Answer 12

MAP >65 mm Hg
CVP 8-12 mm Hg
MVO2 sat > 70%
Adequate UOP
Normal lactate

Question 13

Sepsis guidelines: initial fluid administration

Answer 13

For sepsis-induced hypoperfusion, ≥30 mL/kg IV crystalloid within first 3 hours

Question 14

Administration of empirical broad-spectrum antimicrobials should occur within __ _____ of recognition of sepsis or septic shock

Answer 14

1 hour

Question 15

Fluid resuscitation guidelines for sepsis

Answer 15

1. initially crystalloid
2. continue volume resus as long as patient is responding
3. addition of albumin if requiring substantial quantities of crystalloid to maintain MAP
4. Avoid Hespan

Question 16

adequate perfusion pressures, typically targeted to MAP of…

Answer 16

65 mm Hg

Question 17

First-line vasopressor for management of septic shock

Answer 17

Norepinephrine

Question 18

What other vasopressors may be used? What are the considerations of each?

Answer 18

1. Epinephrine - can be added
2. Low-dose vasopressin (0.03 U/min) - may be used but never as initial treatment!
3. Dobutamine - can be added in presence of myocardial dysfunction or when hypoperfusion persists despite adequacy of intravascular volume and MAP

Question 19

When volume resuscitation and vasopressor therapy DO NOT restore hemodynamic stability, what is recommended?

Answer 19

Hydrocortisone 200 mg per day in four divided doses

Question 20

What is the Hgb target for sepsis?

Answer 20

Transfusion trigger is <7.0 g/dL (in the absence of myocardial ischemia, severe hypoxemia, or acute hemorrhage)

Question 21

Mechanical ventilation parameters for sepsis-induced ARDS:

Answer 21

Target tidal volume: 6 mL/kg
Upper limit plateau pressure: 30 cm H2O
Minimal PEEP

Question 22

Severe refractory hypoxemia may respond to a…

Answer 22

recruitment maneuver

Question 23

prone positioning may be used in patients with a PaO2/FiO2 ratio of…

Answer 23

150 mm Hg or less

Question 24

BG goal for sepsis?

Answer 24

180 mg/dL or less

Question 25

what may be considered for ARF/AKI?

Answer 25

continuous venovenous hemofiltration (CVVH)

Question 26

what are the two general components of the systemic inflammatory response?

Answer 26

1: Acute PROinflammatory response mediated by increased expression of innate immunity genes

2: Secondary ANTI-inflammatory response that modulates proinflammatory phase to affect restoration of homeostasis

Question 27

after severe traumatic injury, how are both components of systemic inflammatory response likely to occur?

Answer 27

simultaneously