Sepsis Flashcards
Sepsis
ABx Therapy :
If meningitis adult …
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
Sepsis
-Carbapenems (imipenem/cilastatin, meropenem, ertapenem, doripenem):
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
Sepsis
Vasopressors:
-Vasopressin:
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
Sepsis
Labs for Sepsis
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
Sepsis
Signs and Symptoms of Sepsis
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
Sepsis
Sepsis =
2 SIRS criteria + suspected or documented infection
Sepsis
Pediatric ABX:
0-28 days: ampicillin 50mg/kg, cefotaxime 50mg/kg (higher in meningitis) , +/- acyclovir 20 mg/kg
28 d +: ceftriaxone 25-50mg/kg
Sepsis
ABx Therapy :
If dental / ENT…
Pen G 4 mil U IV, Clindamycin 900 mg IV, & Metronidazole 1 gm IV
Sepsis
ABx Therapy :
If skin/soft tissue…
Vanc, Zosyn, & Gent
Sepsis
Inotropic:
-Dobutamine:
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
Sepsis
SIRS Criteria:
Temp > 38 or < 36 C
HR > 90
RR > 20 or PCO2 < 32
WBC > 12 or < 4 or > 10% bands
Sepsis
-Vancomycin:
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
Sepsis
Organ dysfunction =
AMS, heart, liver or renal failure, coagulopathy / thrombocytopenia, lactic acidosis, d/t ↓ perfusion
Acute Lung Injury
Sepsis
Antibiotics: start within the first hour. Broad spectrum.
-Vancomycin
-Ceftriaxone
-Zosyn
-Carbapenems
Sepsis
Sepsis 3
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