Sepsis

Question 1

Sepsis

ABx Therapy :
If meningitis adult …

Answer 1

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

Question 2

Sepsis

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

Answer 2

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

Question 3

Sepsis

Vasopressors:
-Vasopressin:

Answer 3

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

Question 4

Sepsis

Labs for Sepsis

Answer 4

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

Question 5

Sepsis

Signs and Symptoms of Sepsis

Answer 5

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

Question 6

Sepsis

Sepsis =

Answer 6

2 SIRS criteria + suspected or documented infection

Question 7

Sepsis

Pediatric ABX:

Answer 7

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

Question 8

Sepsis

ABx Therapy :
If dental / ENT…

Answer 8

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

Question 9

Sepsis

ABx Therapy :
If skin/soft tissue…

Answer 9

Vanc, Zosyn, & Gent

Question 10

Sepsis

Inotropic:
-Dobutamine:

Answer 10

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

Question 11

Sepsis

SIRS Criteria:

Answer 11

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

Question 12

Sepsis

-Vancomycin:

Answer 12

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

Question 13

Sepsis

Organ dysfunction =

Answer 13

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

Question 14

Sepsis

Antibiotics: start within the first hour. Broad spectrum.

Answer 14

-Vancomycin
-Ceftriaxone
-Zosyn
-Carbapenems

Question 15

Sepsis

Sepsis 3

Answer 15

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

Question 16

Sepsis

Treatment:

Answer 16

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

Question 17

Sepsis

Severe sepsis =

Answer 17

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

Question 18

Sepsis

Septic shock =

Answer 18

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

Question 19

Sepsis

-Ceftriaxone:

Answer 19

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)

Question 20

Sepsis

ABx Therapy :
If UTI / abd / pelvic…

Answer 20

Zosyn 4.5 gm IV & Gent, Cipro 400mg IV

Question 21

Sepsis

Vasopressors:
-Dopamine:

Answer 21

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

Question 22

Sepsis

ABx Therapy :
Unknown source or PNA…

Answer 22

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

Question 23

Sepsis

Other Treatments for Sepsis:

Answer 23

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

Question 24

Sepsis

Sepsis Leading Causes

Answer 24

Pneumonia, abdominal infection, urogenital infections

Question 25

# Sepsis Vasopressors: -Epinephrine:

Answer 25

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

Question 26

# Sepsis Vasopressors: -Phenylephrine:

Answer 26

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

Question 27

# Sepsis Vasopressors: -Norepinephrine (levophed):

Answer 27

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

Question 28

# Sepsis Sepsis ABx Therapy : If fungal...

Answer 28

Fluconazole 400mg IV or Caspofungin 70mg IV

Question 29

# Sepsis -Zosyn:

Answer 29

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