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Therapeutics 5 Kappa Epsilon > Exam 5 - Sepsis > Flashcards

Exam 5 - Sepsis Flashcards

1
Q

definition of bacteremia

A

presence of bacteria in the blood

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2
Q

definition of sepsis

A

life threatening organ dysfunction cause by dysregulated host response to infection

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3
Q

SIRS stands for?

A

systemic inflammatory response syndrome

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4
Q

Criteria for SIRS:

Temperature?

A

> 38 C or < 36 C

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5
Q

what are the 4 criteria looked at for SIRS

A

Temp
HR
RR (or PaCO2)
WBC (or bands)

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6
Q

how many of the 4 criteria do you need to have SIRS

A

just 2/4

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7
Q

Criteria for SIRS:

HR?

A

> 90 BPM

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8
Q

Criteria for SIRS:

RR?

A

> 20 breaths/min

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9
Q

Criteria for SIRS:

WBC?

A

> 12,000 or < 4000

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10
Q

need a ______ score to see if pt has sepsis

A

SOFA

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11
Q

Need a __#__ score in SOFA to have sepsis

A

2 or more

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12
Q

what does SOFA stand for

A

sequential (sepsis-related) organ failure assessment

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13
Q

Quick SOFA score (qSOFA): need ____ out ____ criteria means more likely to have poor outcomes

A

need 2 out of 3

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14
Q

what are the 3 criteria for qSOFA score?

A

altered mental status
Systolic BP < 100
RR > 22

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15
Q

definition of septic shock?

A

subset of sepsis
where underlying circulatory, cellular, and metabolic abnormalities are assoc. with high risk of mortality than sepsis alone

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16
Q 
Septic Shock Pts:
Pts require \_\_\_\_\_\_\_\_\_ to maintain a  \_\_\_\_\_\_\_ above 65
AND
\_\_\_\_\_\_\_ > 2 mmol/L ( >18 mg/dL)
in the absence of \_\_\_\_\_\_\_\_
A

require vasopressors; MAP;
serum lactate
hypovolemia

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17
Q

Factors leading to increased incidence of sepsis?

A
  • immunocompromised pts
  • frequent invasive device/procedures
  • more life sustaining technology
  • higher frequency of infections caused by abx resistant organisms
  • Aging population with serious underlying conditions

(overall we are keep people alive longer…..)

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18
Q

what is the most common organism that causes sepsis?

A

enterobacteriaceae

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19
Q

what are examples of enterobacteriaceae

A 
E. Coli
Klebsiella
Enterobacter
Serratia
Proteus
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20
Q

worrying about Pseudomonas aeruginosa in sepsis patients when?

A

mechanical ventilation
prolonged hospitalization
burn injury

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21
Q

Gram - or Gram + will cause sepsis more often and why?

A

Gram - because it has LPS/ENDOTOXIN!

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22
Q

definition of multiple organ dysfunction syndrome?

A

presence of altered organ function in an acutely ill patient so that homeostasis cannot be maintained w/out intervention

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23
Q

what does DIC stand for?

A

disseminated intravascular coagulation

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24
Q

conversion of prekallikrein to bradykinin leads to vasodilation or vasoconstriction?

A

dilation!

like ACEI stuff = dilation = lover BP

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25
Q

Issue of vasodilation with bradykinin?

A

increases capillary permeability = fluid leaks into interstitial space = septic shock

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26
Q

macrophages roll in sepsis?

A

remove/destroy bacteria

produce inflammation mediators

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27
Q

TNF-a stimulates the release of _________ and _______

A

PAF (platelet activating factor)
and
interleukins

28
Q

TNF-a acts on the hypothalamus to cause ______

A

fever

29
Q

what are antiinflammatory mediators?

A

IL-1ra and IL-10

30
Q

Thromboxane A2 or PGI2:

which one causes platelet aggregation and which one inhibits it

A

thrombox: causes aggregation
PGI2: inhibits

31
Q 
General Variables of Criteria Sepsis:
Temperature: > \_\_\_\_C
HR > \_\_\_\_\_\_
(brady or tachy) pnea
altered mental status
significant \_\_\_\_\_\_\_
(hypo or hyper) glycemia
A 
> 38.3 C
> 90 bpm
TACHYpnea
edema
HYPERglycemia
32
Q

what inflammatory marker correlates to bacterial load, severity of infection, and mortality and we use for monitoring need of antibiotics

A

PCT (procalcitonin)

33
Q

For PCT Concentration:

when value is _______ antibiotics are DISCOURAGED

A

< 0.5 ng/mL

if < 0.25 STRONGLY discouraged….

34
Q

For PCT Concentration:

when value is _______ antibiotics are ENCOURAGED

A

when > 0.5 ng/mL

when > 1 STRONGLY encouraged

35
Q

what are things to look at to see if there are any tissue perfusion variable?

A

hyperlactatemia (> 1 mmol/L)

decreased capillary fill

36
Q

Things that could indicate Organ dysfunction:

A SCr change of what?

A

increase of more than 0.5

37
Q

Things that could indicate Organ dysfunction:

Arterial _____oxemia

A

hypoexmia

38
Q

Things that could indicate Organ dysfunction:

Acute ____uria

A

oliguria

39
Q

Things that could indicate Organ dysfunction:
________cytopenia
_______billirubinemia

A

thrombocytopenia (plt ct < 100,000)

hyperbilirubienmia (total bilirubin >4)

40
Q

what things need to happen in the first 3 hours of sepsis?

  • measure _______ concentration
  • obtain ________ prior to administration of abx
  • administer __________
  • administer _________ for _________
A
  • measure lactate concentration
  • obtain blood cultures prior to administration of abx
  • administer broad spec abx
  • administer crystalloids (normal saline or lactated ringer) for hypotension
41
Q

what things need to happen in the first 6 hours of sepsis?

  • apply _______ to maintain MAP > 65 mmHg
  • re-assess ________ and _______ (if initial lactate was high)
  • re-measure ______ if initially elevated
A
  • apply vasopressors to maintain MAP > 65 mmHg
  • re-assess volume status and tissue perfusion (if initial lactate was high)
  • re-measure lactate if initially elevated
42
Q

most likely bacteria to cause urogenital infections?

A 
E. Coli!!!!
Klebsiella
Enterobacter
Serratia
Pseudomonas
43
Q

most likely bacteria to cause respiratory infections (nosocomial)?

A 
pseudomonas!!
S. aureus
klebsiella
enterobacter
E. Coli
serratia
44
Q

most likely bacteria to cause respiratory infections (community)?

A

S. pneumoniae
Legionella pneumophilia
H. influenzae
C. pneumoniae

45
Q

most likely bacteria to cause bowel infections?

A 
Bacteriodes
E. Coli
Klebsiella
Enterobacter
Serratia
46
Q

most likely bacteria to cause biliary tract infections?

A

E. Coli
Klebsiella
Enterobacter
Serratia

47
Q

most likely bacteria to cause reproductive system infections?

A

Bacteriodes
E.Coli
Gram +

48
Q

most likely bacteria to cause skin infections?

A 
gram +
pseudomonas
acinetobacter
klebsiella
enterobacter
serratia
49
Q

For Sepsis – Disease specific treatments:

if CAP?

A

since sepsis know is ICU pt….
will give either Ceftriaxone + azithromycin OR
Ceftriaxone + respiratory FQ

50
Q

what FQs are ok to use for CAP?

A

moxifloxacin or levofloxacin

NOT cipro

51
Q

For Sepsis – Disease specific treatments:

If suspected urinary tract source?

A

3rd/4th gen ceph

Pip/tazo

52
Q

For Sepsis – Disease specific treatments:

if suspected intra-abdominal source?

A

pip/tazo
carbapenem
3rd/4th gen ceph + metronidazole
Cipro or levo + metronidazole

53
Q

For Sepsis – Disease specific treatments:

if suspected skin/soft tissue infection/cellulitis?

A

vanc
linezolid
daptomycin

54
Q

For Sepsis – Disease specific treatments:

for hospital acquired infection: suspected pneumonia

A

(antipseudo beta lactam) + (aminoglycoside or antipseudomonal FQ) +
(vanc or linezolid)

55
Q

For Sepsis – Disease specific treatments:

for hospital acquired infection: suspected UTI

A

Cefepime + AG or FQ
Pip/tazo + AG or FQ

(want pseudomonas coverage)

56
Q

For Sepsis – Disease specific treatments:

for hospital acquired infection: suspected intra-abdominal infection

A

pip/tazo
carbapenem (NOT erta!!)
(want pseudomonas coverage)

57
Q

For Sepsis – Disease specific treatments:

for hospital acquired infection: suspected skin and soft tissue infections?

A

vanc + pip/tazo (+ clindamycin if necrotizing fasciitis)

58
Q

For Sepsis – Disease specific treatments:

for hospital acquired infection: if suspected indwelling vascular catheter infection

A

vanc
dapto
linezolid

59
Q

how to treat sepsis?

A

7 - 10 days

60
Q

Vasopressor Facts:

target a MAP of ______

A

65 mmHg

61
Q

Vasopressor Facts:

________is a first choice drug

A

NE (norepinephrine)

62
Q

Glucose control and sepsis?

A

do NOT tightly control it!!!

issues of hypoglycemia happen a lot

63
Q

Use corticosteroids in sepsis?

A

yes!

64
Q

DVT prophylaxis for sepsis pts?

A

yes – LMWH or LDUH (low dose unfractionated heparin)

65
Q

best to limit nutrition or increase nutrition with sepsis patients?

A

more increase/maintain for sure because sepsis is high expenditure

66
Q

other options than NE for vasopressor?

A

epinephrine
vasopressin
dopamine
phenylephrine

67
Q

how to find MAP?

A

diastolic P + (1/3)(systolic P - diastolic P)

Therapeutics 5 Kappa Epsilon (27 decks)

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