fever and SIRS/sepsis I Flashcards
1
Q
systemic inflammatory response (SIRS)
A
- inflammatory state of whole body –> response due to infectious or noninfectious insult**
- causes: trauma, burns, surgery, anaphylaxis, shock, ischemia etc.**
- 2x more likely to be infected and higher risk of mortality with SIRS
2
Q
criteria for SIRS**
A
- Temperature greater than 38°C (100.4°F) or less than 36°C (96.8°F)
- Heart rate greater than 90 beats per minute.
- Respiratory rate greater than 20 or PaC02 less than 32.
- WBC greater than 12,000, or less than 4,000, or with greater than 10% band forms.
3
Q
sepsis**
A
- old definition: SIRS with suspected infection (not used anymore)
- new definition*: life threatening organ dysfunction caused by a dysregulated host response to infection (no SIRS component)
- do not have to be septic just bc you have infection
4
Q
organ dysfunction
A
-increase in 2 or more points on SOFA score
5
Q
severe sepsis
A
- sepsis with acute organ dysfunction (no longer used)
- may still see it for coding and reimbursement
6
Q
septic shock***
A
- sepsis with persisting hypotension, requiring vasopressors to maintain MAP >65mmHg and lactate levels >2mmol/L despite volume resuscitation**
- high risk of death
- mortality rate order: sepsis –> septic shock –> multiorgan dysfunction syndrome (MODS)
7
Q
multiorgan dysfunction syndrome (MODS)**
A
- multiple organ/multisystem failure from infection, injury, hypo perfusion, hyper metabolism
- sepsis most common cause**
- sepsis + MODS –> high mortality rate
8
Q
bacteremia
A
-bacterial infection in bloodstream
9
Q
septicemia
A
-bloodstream infection with many organisms
10
Q
SOFA (Sequential Organ Failure Assessment) score
A
- address severity of organ dysfunction in patients ill from sepsis (usually used in ICUs)
- scores calculated 24 after admission, every 48 hr. after that
- 6 categories (0-4 points/categorie)
- measure: PaO2/FiO2, Platelet count, Bilirubin level, BP and need for vasopressors, Glascow Coma Scale, and Creatinine level
- > or = 15 points –> 90% mortality, > or = 11 –> 50% mortality
- Logistic organ failure system (LODS)** also used in ICU
11
Q
qSOFA (quick Sequential Organ Failure Assessment) score
A
- used more broadly, faster, less blood tests
- assess patients with suspected infection –> done outside the ICU***
- 3 criteria***: low BP (systolic < or = 100mmHg), high respiratory ( > or = 22 bpm), altered mentation (Glascow coma scale <15)
- score > or = 2 –> might want to put them in ICU for close monitoring due to high risk of poor outcome**
12
Q
sepsis bundles*** 1-3 hr. bundle (time 0 is triage)
A
- during 1st hour: BLOOD and urine cultures always (wound and other cultures if necessary) before antibiotics; broad spectrum antibiotics immediately after; measure lactate levels (remeasure after volume resuscitation if initial one was >2mmol/L)***
- during next 3 hrs: volume resuscitation in hypotensive and septic –> give 30mL/Kg crystalloid (0.9NR or LR)* if hypotensive or lactate level > or = 4 on arrival; if still hypotensive, give vasopressors to maintain MAP (> or = 65mmHg)**
13
Q
sepsis bundles*** 6 hr. bundle
A
- everything prior + start vasopressors and repeat lactate (if initial was high) if still hypotensive despite volume resuscitation
- if hypotension still persists –> measure CVP with central line (want CVP > or = 8mmHg) and measure mixed venous O2 sat. from SVC (want > or = 70%)
- normalize lactate level
14
Q
sepsis bundles*** measure tissue perfusion
A
- need to document tissue perfusion anywhere in that 3-6hr. time frame
1. passive leg raise - look at pulse pressure, CO/SV
2. capillary refill
3. measure CVP (central venous pressure) - central line in SVC
4. mixed venous O2 sat. - from pulmonary line or central line in SVC
5. IVC respiratory variation in diameter - use ECHO
15
Q
the exam during septic shock**
A
- very focused H&P while doing exam (quickly!!)
- listen to pods point and examine other areas
