Sepsis Flashcards

1
Q

Sepsis

ABx Therapy :
If meningitis adult …

A

Decadron 10 mg IV
Rocephin 2gm IV
Vanc 15-20 mg/kg IV
Ampicillin 1 gm IV (If immune compromised)
Plus minus Acyclovir 10mg/kg IV

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2
Q

Sepsis

-Carbapenems (imipenem/cilastatin, meropenem, ertapenem, doripenem):

A

Broadest spectrum of antibiotics, gram positives,
gram neg including pseudomonas and ESBL, anaerobes. Does Not cover MRSA, most VRE, atypicals, stenotrophomonas.
Ertapenem does not cover pseudomonas. Lowers seizure threshold

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3
Q

Sepsis

Vasopressors:
-Vasopressin:

A

Antidiuretic hormone. 0.03/units/min.
Use as second-line agent in refractory.
Can be added to NE.
Has no effect if not deficient in vasopressin so can start early

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4
Q

Sepsis

Labs for Sepsis

A

CBC, BMP, hepatic function, PT, PTT, INR, Lactic acid, VBG, D-stick, UA, Ucx, Bcx, type and screen, troponin, procalcitonin, CXR, EKG, LP, possible CT head

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5
Q

Sepsis

Signs and Symptoms of Sepsis

A

Neurology: AMS, septic encephalopathy
CV: myocardial depression, distributive shock (flushed warm skin → mottled and cyanotic)
Pulm: R–>L shunting, arterial hypoxia, ARDS
GI: ileus, increase in LFTs, bili, splanchnic
Endo: adrenal
Heme: DIC, protein C
Renal: oliguria

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6
Q

Sepsis

Sepsis =

A

2 SIRS criteria + suspected or documented infection

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7
Q

Sepsis

Pediatric ABX:

A

0-28 days: ampicillin 50mg/kg, cefotaxime 50mg/kg (higher in meningitis) , +/- acyclovir 20 mg/kg
28 d +: ceftriaxone 25-50mg/kg

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8
Q

Sepsis

ABx Therapy :
If dental / ENT…

A

Pen G 4 mil U IV, Clindamycin 900 mg IV, & Metronidazole 1 gm IV

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9
Q

Sepsis

ABx Therapy :
If skin/soft tissue…

A

Vanc, Zosyn, & Gent

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10
Q

Sepsis

Inotropic:
-Dobutamine:

A

Beta 1 → increase inotropy and chronotropy. Used when myocardial dysfunction (elevated cardiac filling
pressures and low CO) or ongoing signs of hypoperfusion, despite adequate intravascular volume and MAP. 5-20 mcg/kg/min

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11
Q

Sepsis

SIRS Criteria:

A

Temp > 38 or < 36 C
HR > 90
RR > 20 or PCO2 < 32
WBC > 12 or < 4 or > 10% bands

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12
Q

Sepsis

-Vancomycin:

A

15-20 mg/kg q8-12 hours- inhibits cell wall synthesis in Gram positives. gram positive agent with activity against staph (MRSA), strep and non VRE enterococcus

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13
Q

Sepsis

Organ dysfunction =

A

AMS, heart, liver or renal failure, coagulopathy / thrombocytopenia, lactic acidosis, d/t ↓ perfusion
Acute Lung Injury

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14
Q

Sepsis

Antibiotics: start within the first hour. Broad spectrum.

A

-Vancomycin
-Ceftriaxone
-Zosyn
-Carbapenems

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15
Q

Sepsis

Sepsis 3

A

SOFA- Hypotension (SBP <100), Altered mental status (<15), Tachypnea (RR> 22)

Sepsis- SOFA score of 2

Septic shock- sepsis and persistent hypotension requiring pressors and lactate > 2

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16
Q

Sepsis

Treatment:

A

Early airway management
Circulatory resuscitation goals:
MAP > 65
Urine output > 0.5-1 ml/kg/hr
CVP > 8mm Hg
CV oxygen saturation > 70%
Decreasing lactate concentration
Fluid resuscitation may require 6-10L
Vasopressor if MAP < 65 after 40 ml/kg bolus

17
Q

Sepsis

Severe sepsis =

A

Sepsis + ↓BP (SBP < 90 or MAP < 65) before IVF, or organ dysfunction, or Lactate ≥ 4

18
Q

Sepsis

Septic shock =

A

Severe sepsis + persistent ↓BP despite IVF (req pressors)

19
Q

Sepsis

-Ceftriaxone:

A

1-2 g daily, 2g q12 for meningitis. good gram positive, excellent gram negative (e. coli, proteus, klebsiella,
neisseria, H. influenzae)
- No pseudomonas coverage or anaerobes ( Ceftazidime and cefepime cover pseudomonas, Cefoxitin
and cefotetan cover anaerobic, ceftaroline covers enterococcus)

20
Q

Sepsis

ABx Therapy :
If UTI / abd / pelvic…

A

Zosyn 4.5 gm IV & Gent, Cipro 400mg IV

21
Q

Sepsis

Vasopressors:
-Dopamine:

A

Used as second line in those with absolute or relative bradycardia and a low risk of tachyarrhythmias. 2-20
mcg/min

22
Q

Sepsis

ABx Therapy :
Unknown source or PNA…

A

Vancomycin 20mg/kg IV, Zosyn 4.5gm (or Gentamycin 7mg/kg IV) & Levaquin 750 mg IV (or Moxi ox
400mg IV)

23
Q

Sepsis

Other Treatments for Sepsis:

A

Source control
Consider: steroids in adrenal insufficiency, blood products
ARDS settings: Tidal volume: 6mL/kg, upper limit of plateau pressure <30, PEEP, head of bed elevated, glucose control, DVT and ulcer
prophylaxis, nutrition

24
Q

Sepsis

Sepsis Leading Causes

A

Pneumonia, abdominal infection, urogenital infections

25
Q

Sepsis

Vasopressors:
-Epinephrine:

A

Potent beta 1 and moderate beta 1 and alpha 1- needs high dose for vasoconstriction. can cause dysrhythmias,
splanchnic vasoconstriction. Second line. 5-20 mcg/kg

26
Q

Sepsis

Vasopressors:
-Phenylephrine:

A

Alpha 1 agonists. used when NE is associated with serious arrhythmias, CO is known to be high and BP is
persistently low or as salvage therapy when combined inotrope/vasopressor and low dose vasopressin has failed. 2-20
mcg/min

27
Q

Sepsis

Vasopressors:
-Norepinephrine (levophed):

A

Alpha 1 and beta 1 adrenergic receptors→ vasoconstriction and modest increase in CO.
Preferred treatment. 2-12 mcg/kg. Start at 0.5-1 mcg/min and titrate to effect. consider early, decrease amount of fluid needed

28
Q

Sepsis

Sepsis
ABx Therapy : If fungal…

A

Fluconazole 400mg IV or Caspofungin 70mg IV

29
Q

Sepsis

-Zosyn:

A

3.375 g q6 or over 4 hours, q8 and 4.5 g q6 for PNA/pseudomonas coverage. gram positive, gram negative, anaerobic, pseudomonas, spice a organisms