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Critical Care > Sepsis > Flashcards

Sepsis Flashcards

1
Q

What is the definition of sepsis?

A

life-threatening organ dysfunction caused by a dysregulated host response to infection

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2
Q

How is organ dysfunction secondary to sepsis defined?

A

increase of >2 points in SOFA score

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3
Q

How is septic shock identified?

A
  • clinically identified as patients meeting criteria for sepsis who, despite fluids,
  • require vasopressors to maintain MAP >65
  • AND have a lactate > 2mmol/L
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4
Q

How is SIRS defined?

A

2/4 of these

  • Temp >38C
  • HR >90bpm
  • RR >20
  • WBC >12,000
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5
Q

Based on Sepsis 2.0 definition how are the following defined:

a. sepsis
b. severe sepsis
c. septic shock

A

a. sepsis = SIRS + infection
b. severe sepsis = sepsis + organ dysfunction
c. septic shock = sepsis + decrease BP refractory to bolus of IVF (30cc/kg)
* last stage is MODS

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6
Q

What is the sepsis bedside criteria (e.g. qSOFA) ? (think: HAT)

qSOFA = Sepsis 3.0

A
  • hypotension (SBP <100)
  • altered mental status (GCS <15)
  • tachypnea (RR >22)
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7
Q

What does qSOFA stand for?

A
  • quick sepsis-related organ failure assessment
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8
Q

Based on sepsis 3.0 how is septic shock defined?

A
  • Sepsis
  • AND vasopressors to maintain MAP > 65mmHg
  • AND serum lactate > 2

in the absence of hypovolemia

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9
Q

Based on the SOFA score how is organ dysfunction defined?

A
  • an acute change in total SOFA score >2 points
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10
Q

What is the difference in accuracy between qSOFA and SIRS?

A
  • qSOFA has poor sensitivity and moderate specificity

- SIRS has sensitivity superior to that of qSOFA

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11
Q

What is the spectrum of pathophysiology of sepsis?

A

Infection > dysregulated host response > sepsis > septic shock > MODS > death

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12
Q

How has the evolution in therapy for sepsis evolved?

A

goal-directed therapy > early goal-directed therapy > NOW: EARLY THERAPY

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13
Q

What were the essential elements of care for sepsis 2.0? (6 part)

  • not including: early identification
A
  • antibiotics within 1 hour
  • initiate EGDT within 2 hours
  • central line within 2 hours
  • CVP 8-15 within 6 hours
  • ScVO2 >70% within 6 hours
  • MAP >65 within 6 hours
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14
Q

What are the essential elements of care for sepsis 3.0?

A

IN 1 HOUR

  • ED Triage time to antibiotics
  • blood cultures BEFORE antibiotics
  • use broad spectrum antibiotics

IN 3 HOURS

  • lactate within 3 hours
  • give 30ml/kg bolus to increase BP

IN 6 HOURS

  • vasopressors to goal MAP >65
  • recheck lactate
  • reassess volume status and tissue perfusion
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15
Q

What is the goal urine output when treating sepsis?

A

> 0.5 mL/kg/h (~30cc/hr)

MAGIC NUMBER = 30cc/hr

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16
Q

What is the most common static measure of volume and perfusion assessment?

A

lactate clearance

*CMS wants <2.0 mmol/L

17
Q

What are the 3 common dynamic measures of volume and perfusion assessment?

A
  • fluid challenge
  • passive leg raise
  • bedside cardiac echo (IVC variation)
18
Q

What does lactate identify?

A

global hypoperfusion

19
Q

Lactate of ____ doesn’t go to the floor. but survival drops quickly when it is > _____

A

Lactate of 4 doesn’t go to the floor. but survival drops quickly when it is > 2

20
Q

CVP is used to determine what component of stroke volume?

A

preload

21
Q

ScVO2 correlates to what?

A

delivery of oxygen (DO2)

*DO2 basically = CO

22
Q

A SVO2 > ____ % indicates a normal extraction.

A

> 75%

23
Q

A SVO2 of ____ % indicates compensatory increase in O2.

A

50-75%

24
Q

A SVO2 of ____ % indicates exhaustion of extraction and the beginning of lactic acidosis.

A

30-50%

25
Q

A SVO2 of ____ % indicates severe lactic acidosis

A

25-30%

26
Q

A SVO2 of < ____ % indicates cellular death

A

<25%

27
Q

A SVO2 >75% with a high lactate indicates what?

A

mitochondrial dysfunction and decrease extraction

28
Q

You want to be putting vasopressor through what line?

A

central line

you want arterial line to assess BP in real time

29
Q

What are the 2 pressors commonly used in septic shock?

A
  • norepinephrine

- phenylephrine

30
Q

What medication would you use in vasopressor REFRACTORY septic shock?

A
  • vasopressin 0.04 units/min IV
  • consider empiric STEROIDS for possible adrenal insufficiency
  • consider DOBUTAMINE if reduced C.O.
31
Q

How does dopamine receptor response vary with dose?

A
  • low dose = dopamine
  • medium dose = beta, dopamine
  • high dose = dopamine, alpha, beta
32
Q

Which medication is pure alpha?

A

phenylephrine

33
Q

Which medication is pure beta?

A

isoproterenol

34
Q

Which medication is the “go to” for shock?

A

norepinephrine

35
Q

Which medication is the “pure” inotrope?

A

dobutamine

36
Q

What is considered the “kitchen sink” of medication?

A

epinephrine

Critical Care (8 decks)

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