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Sepsis > SCC Campaign > Flashcards

SCC Campaign Flashcards

1
Q

What does PIRO stand for?

A

Predisposition
Insult/Infection
Response
Organ Dysfunction

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2
Q

What is Norepinephrine’s activity?

A

Primarily α-agonist with minimal β-1 receptor agonist activity

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3
Q

What is Dobutamine’s activity?

A

Strong β-1 agonist, some β-2 and α-1

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4
Q

What is Vasopressin’s activity?

A

Non-catecholamine vasoconstrictor acting via the V1 receptor

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5
Q

What is Epinephrine’s activity?

A

Potent α1, 2 and β1, 2 agonist

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6
Q

Define Sepsis.

A

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

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7
Q

Define Severe Sepsis.

A

Sepsis complicated by dysfunction of one or more organs

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8
Q

Define Septic Shock.

A

Acute circulatory failure and persistent arterial hypotension (despite volume resuscitation) associated with sepsis.

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9
Q

What does APACHE stand for?

A

Acute physiological and chronic health evaluation

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10
Q

Define Cardiac Index.

A

The cardiac output indexed to body surface area and is a more accurate value for comparing cardiac output in animals of varying sizes

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11
Q

Define PAMP. Name a molecule that is a type of PAMP that is a potent stimuli of the host immune response

A

Pathogen-associated molecular pattern – LPS gram gram-negative bacterial cell walls

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12
Q

Define CARS

A

Compensatory anti-inflammatory response syndrome

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13
Q

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?

A

Nitric Oxide

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14
Q

Name the four hallmarks of sepsis.

A

(1) Dysregulation of vasomotor tone
(2) Increased vascular permeability
(3) Dysfunctional microcirculation
(4) Coagulation abnormalities

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15
Q

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

(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.

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16
Q

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

A

(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

17
Q

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

A

(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%)

18
Q

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.

A

False.

19
Q

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

(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

20
Q

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?

A

False

21
Q

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?

A

False

22
Q

In the Oostdik et al study, what was the most frequent cause of bacteria during selective digestive tract decontamination?

A

P. aeruginosa

23
Q

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.

A

Tissue plasminogen activator

DNase

24
Q

Name the four values considered during the first 6 hours of resuscitation. If you can name the values, you will get double points

A
  • 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
25
Q

If you suspect or recognize septic shock or severe sepsis without septic shock in a patient, within what time frame should you administer IV antimicrobials?

A

Within the first hour of recognition

26
Q

True/False – The SSC recommends use of hydroxyethyl starches for fluid resuscitation of severe sepsis and septic shock

A

False

27
Q

According to the SCC guidelines, what is the first choice vasopressor?

A

NE

28
Q

What is your target MAP when starting vasopressor therapy?

A

65 mmHg

29
Q

According to the SCC guidelines, what is the second choice vasopressor?

A

Epinephrine

30
Q

According to the SCC guidelines, should corticosteroids be used if adequate fluid resuscitation and vasopressor therapy are unable to restore hemodynamic stability in adult septic shock patients?

A

Yes

31
Q

According to the SCC guidelines, Once tissue hypoperfusion has resolved and in the absence of extenuating circumstances, such as myocardial ischemia, acute hemorrhage or ischemic heart disease, we recommend that RBC transfusion occur only when Hgb concentration decreased to

A

True

32
Q

According to the SCC guidelines, a target tidal volume of ___ mL/kg predicted body weight in patients with sepsis-induced ARDS is recommended.

A

6 mL/kg

33
Q

The SSC guidelines recommend measuring lactate within the first ____ hours of admission and promptly initiating fluid resuscitation for patients with lactate concentrations ____ mmol/L or greater.

A

Within the first 6 hours of admission with lactate concentrations 4 mmol/L or greater

Sepsis (1 decks)

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