IM Essentials: Ch. 64 - Sepsis Syndrome

Question 1

What percent of cases of sepsis are from Gram-positive organisms?

Answer 1

> 50%

Question 2

Once again, review the following terms: 
•SIRS
•Sepsis
•Severe sepsis
•Septic shock

Answer 2

•SIRS: at least two of the following:

• HR > 90
• RR > 22 or PaCO2 < 32 mm Hg
• WBC <4 or >12
• T <36 or >38
• Sepsis: SIRS plus infectious source
• Severe sepsis: SIRS, infectious source, and organ dysfunction (e.g., hypoxia, AKI, transaminitis, shock, AMS)
• Septic shock: Sepsis plus hypotension refractory to fluid treatment

Question 3

Serum lactate levels have been correlated with __________________.

Answer 3

the degree of global tissue hypoxia, the severity of sepsis, and mortality risk; goal-directed therapy should aim at normalization of serum lactate

Question 4

List three labs that suggest fungal infection.

Answer 4

• 1,3 beta-D-glucan
• Galactomannan
• Anti-mannan antibodies

Question 5

What two things indicate 30 ml/kg fluid resuscitation?

Answer 5

• Hypotension

* Lactate ≥ 4

Question 6

Give vasopressors to ___________.

Answer 6

maintain MAP ≥65 mm Hg in those with hypotension not responding to the three boluses

Question 7

What glucose control is recommended for those in sepsis?

Answer 7

140 to 200

If a patient has two consecutive glucose measurements > 180, begin monitoring levels and giving insulin for levels > 200.

Question 8

Discuss the research on target Hgb.

Answer 8

For patients in sepsis, a range of 7 to 9 resulted in no difference in outcomes than the usual > 10 guideline