Infection Flashcards
Sepsis
Life threatening organ dysfunction caused by a dysregulated host response to infection which can lead to tissue, organ failure, and death
Septic Shock
A subset of sepsis in which circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone
What is phase 1 of septic shock called?
- Early
- Warm shock
What happens during phase 1 of septic shock?
- Vasodilation
What are the s/s of early septic shock?
- Normal - hypotensive r/t fluid shifts
- Hyperthermia r/t septicemia
- Tachycardia
- Tachypnea
- Skin warm and flushed
- Normal urine output
What is phase 2 of septic shock called?
- Late
- Cold
What happens during phase 2 of septic shock?
- Poor perfusion
What are the s/s of late septic shock?
- Hypotension
- Normal - hypothermic
- Tachycardia
- Dysrhythmias
- Tachypnea
- Altered mental status
- Skin pillow/grayish
- Mottled skin
- Edematous
- Urine output <0.5 ml/kg/hour
Multiple organ dysfunction syndrome (MODS)
Failure of 2 or more systems in the body
Disseminated intravascular coagulation (DIC)
Clotting cascade activation, causing both clotting and eventually bleeding after platelets and clotting factors are used up by excessive clotting
Hyperglycemia during sepsis
Continued stress response of the body trigger ongoing liver release of stored glucose
What are MDROs?
Multi-drug resistant organisms
What bacteria causes MRSA?
S. aureus
Where is S. aureus normally found on the body?
- Skin
- Perineum
- Nose
VRE infections
Enterococci bacteria live in intestinal tract normally, but when moved to another area in the body they can cause infection
What antibiotics are used to treat MRSA?
- IV vancomycin
- IV ceftaroline
- Oral Linezolid
S/S of sepsis
- Confusion/mental status changes
- Tachypnea
- Tachycardia
- Fever/hypothermia
- Pain/discomfort
- Clammy/sweaty skin
Systemic Inflammatory Response Syndrome (SIRS)
Ids people who show signs of infection or inflammation who may be at risk for sepsis
SIRS criteria for risk of having sepsis
- Need 2 or more criteria
- Temp: >38.3 or <36.0
- Heart rate: >90/min
- Respiratory rate >20/min
- WBC: <4,000 or >12,000 or bands >10%
Quick Sequential Related Organ Failure Assessment (qSOFA)
- Used outside of ICUs
- Simple bedside criteria to id patients suspected of having infection and poor outcomes
qSOFA scoring
- Hypotension SBP <100 = 1 pt
- Altered mental status/BCS <15 = 1 pt
- Tachypnea >22/min = 1 pt
Sequential Organ Failure Assessment (SOFA)
- Used in ICUs
- Predicts sepsis related organ dysfunction, extent/progression. effects of treatment
- Score of 2 or higher = higher risk of organ dysfunction and poor outcomes
MEWS Screening Tool
- IDs patients at risk for clinical deterioration
- Score of 5 or more = higher risk of death and ICU admission
What is lactate/lactic acid
Byproduct of cell metabolism that accumulates when cells lack sufficient oxygen
Lactic acidosis lactate levels
> 4 mol/L
Normal lactate levels
0.5 - 1 mol/L
Concerning lactate levels for sepsis
> 2 mol/L
What is the first vasopressor preferred in sepsis
Norepinephrine (Levophed)
What is the second choice of vasopressor for sepsis
- Epinephrine
- Phenylephrine
- Vasopressin
Glasgow Coma Scale Eye Opening Response Scoring
- Spontaneously = 4
- To speech = 3
- To pain = 2
- No response = 1
Vasopressor
Medication that increases cardiac output and SVR by increasing heart rate, heart contractility, and induces peripheral vasconsctriction
Glasgow Coma Scale Verbal Response Scoring
- Oriented to time, pace, person = 5
- Confused = 4
- Inappropriate words =3
- Incomprehensible sounds = 2
- No response = 1
Glasgow Coma Scale Motor Response Scoring
- Obeys commands = 6
- Moves to localized pain = 5
- Flexion withdrawal from pain = 4
- Abnormal flexion/decorticate = 3
- Abnormal extension/decerebrate = 2
- No response = 1
