SCC Campaign Flashcards
(33 cards)
What does PIRO stand for?
Predisposition
Insult/Infection
Response
Organ Dysfunction
What is Norepinephrine’s activity?
Primarily α-agonist with minimal β-1 receptor agonist activity
What is Dobutamine’s activity?
Strong β-1 agonist, some β-2 and α-1
What is Vasopressin’s activity?
Non-catecholamine vasoconstrictor acting via the V1 receptor
What is Epinephrine’s activity?
Potent α1, 2 and β1, 2 agonist
Define Sepsis.
The clinical syndrome caused by infection and the host’s systemic inflammatory response to it; may be of bacterial (gram positive or gram negative), viral, protozoal or fungal origin
Define Severe Sepsis.
Sepsis complicated by dysfunction of one or more organs
Define Septic Shock.
Acute circulatory failure and persistent arterial hypotension (despite volume resuscitation) associated with sepsis.
What does APACHE stand for?
Acute physiological and chronic health evaluation
Define Cardiac Index.
The cardiac output indexed to body surface area and is a more accurate value for comparing cardiac output in animals of varying sizes
Define PAMP. Name a molecule that is a type of PAMP that is a potent stimuli of the host immune response
Pathogen-associated molecular pattern – LPS gram gram-negative bacterial cell walls
Define CARS
Compensatory anti-inflammatory response syndrome
In patients with severe sepsis/septic shock, there is dysregulation of vasomotor tone leading to a vasodilatory state. Overproduction of what agent is the major factor contributing to this?
Nitric Oxide
Name the four hallmarks of sepsis.
(1) Dysregulation of vasomotor tone
(2) Increased vascular permeability
(3) Dysfunctional microcirculation
(4) Coagulation abnormalities
In the Rubulotta et al retrospective study in CCM 2009, they concluded the following - Circle all that apply:
(a) The utility of the PIRO model for risk assessment in patients with severe sepsis shows that each variable contributes to outcome prediction with a 30% to 50% increase in odds of death.
(b) In the PROGRESS dataset, all PIRO components were significant and were similar in their increase in risk of death for every one-point increase (odds ratios range from 1.3-1.5 for one level increase)
(c) The utility of the PIRO model for risk assessment in patients with severe sepsis shows that each variable contributes to outcome prediction with a 70% to 80% increase in odds of death.
(d) In the PROGRESS dataset, all PIRO components were significant and were similar in their increase in risk of death for every three-point increase (odds ratios range from 1.3-1.5 for one level increase)
(a) The utility of the PIRO model for risk assessment in patients with severe sepsis shows that each variable contributes to outcome prediction with a 30% to 50% increase in odds of death.
In the Zahar et al prospective observational cohort study in CCM 2011, they concluded the following - Circle the one that is correct
(a) The type of infectious process is a strong prognostic factor
(b) Early appropriate antimicrobial therapy was not consistently associated with better survival in the community-acquired and ICU-acquired groups
(c) The type of infectious process may not exert as strong a prognostic effect when severity, organ dysfunction and appropriateness of early antimicrobials are taken into account
(d) In this study, the lungs, abdomen and urinary tract accounted for approximately 10% of cases of severe sepsis
(c) The type of infectious process may not exert as strong a prognostic effect when severity, organ dysfunction and appropriateness of early antimicrobials are taken into account
DeClue et al evaluated the diagnostic/prognostic utility of serum NT-pCNP and noted the following - Circle all that apply:
(a) Serum NT-pCNP concentration was associated with survival in the sepsis group
(b) Serum NT-pCNP concentration was not associated with survival in the sepsis group
(c) For nonperitoneal sources of sepsis, serum NT-pCNP has a good sensitivity (92%)
(d) Serum NT-pCNP has a poor specificity for peritoneal sources of sepsis
(b) Serum NT-pCNP concentration was not associated with survival in the sepsis group
(c) For nonperitoneal sources of sepsis, serum NT-pCNP has a good sensitivity (92%)
DeClue et al evaluated the diagnostic/prognostic utility of serum NT-pCNP and noted the following - Is this statement true or false?
-When dogs in the peritoneal subgroup were removed from analysis, the sensitivity worsened to 50% and the specificity remained the same for differentiating dogs with sepsis from dogs with NSIRS or healthy control dogs.
False.
In the Vasopressin vs. NE infusion in patients with septic shock - NEJM study 2008, the following conclusions/results were found. Circle all that apply:
(a) There were no significant differences in the overall rates of serious adverse events
(b) Low-dose vasopressin did not reduce mortality rates as compared with NE among patients with septic shock who were treated with catecholamine vasopressors
(c) Low-dose vasopressin did reduce mortality rates as compared with NE among patients with septic shock who were treated with catecholamine vasopressors
(d) There was no significant difference in 28-day mortality rate or 90 day mortality rate, but there was in organ dysfunction
(a) There were no significant differences in the overall rates of serious adverse events
(b) Low-dose vasopressin did not reduce mortality rates as compared with NE among patients with septic shock who were treated with catecholamine vasopressors
In the NE + dobutamine vs. epinephrine alone for management of septic shock study (Lancet 2007), there was evidence for using NE+dobutamine over epinephrine - True/False?
False
In the NE + dobutamine vs. epinephrine alone for management of septic shock study (Lancet 2007), there were serious myocardial side effects noted with the use of epinephrine - True/False?
False
In the Oostdik et al study, what was the most frequent cause of bacteria during selective digestive tract decontamination?
P. aeruginosa
What two agents were used intrapleurally for pleural infection in the Rahman et al study which revealed improved fluid drainage in patients with pleural infection and reduction of the frequency of surgical referral and duration of hospitalization.
Tissue plasminogen activator
DNase
Name the four values considered during the first 6 hours of resuscitation. If you can name the values, you will get double points
- CVP 8-12 mmHg
- MAP > or equal to 65 mmHg
- UOP > or equal to 0.5 mL/kg/hr
- Central venous (superior vena cava) or mixed venous oxygen saturation 70% or 65% respectively
