OnlineMedEd: Infectious Disease - "Sepsis"

Question 1

True or false: the infection has to spread in order for sepsis to develop.

Answer 1

False

Sepsis describes the SIRS signs with an infectious source. SIRS can develop in the context of a local infection.

Question 2

Review the SIRS criteria.

Answer 2

At least two of the following: 
•Temp: < 36 or > 38
• WBC: < 4 or > 12
• HR: > 90 
• RR: > 20 or PaCO2 < 32

Question 3

In general, the SIRS criteria should be used to do what?

Answer 3

Screen for infectious syndromes

SIRS does not mean infectious sepsis –for instance, you likely are SIRS-positive when you exercise –but it helps to catch cases of infection.

Question 4

Review the basic signs of organ dysfunction.

Answer 4

• Brain: AMS
• Heart: hypotension
• Kidneys: elevated BUN and creatinine
• Liver: transaminitis
• Lungs: ARDS

Question 5

Review the definitions of these terms:

• SIRS
• Sepsis
• Severe sepsis
• Septic shock
• Multiorgan dysfunction syndrome (MODS)

Answer 5

• SIRS: two or more of the SIRS criteria
• Sepsis: SIRS + source
• Severe sepsis: SIRS + source + hypotension responsive to fluids (or other sign of organ dysfunction)
• Septic shock: SIRS + source + hypotension refractory to fluids
• MODS: SIRS + source + hypotension refractory to fluids + another organ dysfunction

Question 6

Why is the distinction between severe sepsis and septic shock important?

Answer 6

Those with severe sepsis can be admitted to the floor, while those with septic shock need to go to the ICU.

Question 7

Describe the goals of sepsis therapy.

Answer 7

• CVP between 10-12
• Urinary output > 0.5 ml/kg/hr
• MAP > 65 mm Hg
• Mixed venous O2 > 70%

Question 8

Explain the initial treatment for sepsis.

Answer 8

• Antibiotics
• Fluids (generally about 2-3 L)
• Remove source (e.g., central line)
• Vasopressors