Sepsis Flashcards
sepsis
-constellation of symptoms in response to infection
-dysregulated response and new organ dysfunction related to infection
-body’s extreme response to infection
criteria for sepsis….. suspected of confirmed infection with two of the following:
-fever (greater than 100.9)
-hypothermia (less than 97F)
-HR >90
-Tachypnea >22
-SBP <100 mm Hg
-altered mental status
-edema or positive fluid balance
-Hyperglycemia (>140 w/o diabetes)
-WBC >12k
-WBC<4k
-arterial hypotension (SBP <, MAP <70, decrease in SBP >40)
-acute oliguria
-serum creatinine increase
coagulation abnormalities
-ileus (absent bowel sounds)
-thrombocytopenia
-hyperbilirubinemia
-decreased cap refill; or mottling
first sign of sepsis
respiratory
infection sources for sepsis
pneumonia, UTI, ETtube, foley, etc
what is the MAP needed for adequate perfusion
greater than 60
what MAP indicated sepsis/ septic shock?
> 65
risk factors for sepsis
-immunosuppression (cancer, AIDs, transplant, chronic steroids, Lupus)
-extremes of age (less than 1 year, greater than 65)
-malnourishment
-chronic illness (DM, Hepatitis, CKD)
-invasive procedures
-emergent and/or multiple surgeries
treatment for sepsis (1 hour bundle)
-obtain lactate
-obtain blood cultures x2
-administer broad spectrum ABX
-30mL/kg crystalloid (LR) for hypotension or lactate >4
-administer vasopressors during or after fluid to maintain MAP >65 (even peripheral line in emergencies)
remeasure lactate if initial, lactate is elevated (>2)
lactate
normal lactate = 0.5 -2.2
high lactate can lead to lactic acidosis and depresses major organs
blood cultures
-usually 2 sites (b/c could have embolism on skin
-must fill bottle to what is labeled
-must do cultures before administering antibiotic
-draw aerobic first then anaerobic
why do we give LR?
closer to blood pH
what size IV do you use for IV fluids during sepsis?
20g or higher
what to watch for when infusing IV fluids
-IV infiltration
-SOB/difficulty breathing
-BP response
vasopressors
-used to support BP
-must be in ICU
-must be administered via central line b/c caustic to skin
-only used if you can’t get BP up after install intervention
examples of vasopressors
-epinephrine, norepinephrine
tool used to predict mortality
qSOFA
What BP is unstable?
SBP less than 100
qSOFA assessment tool
if 2 or more of the following criteria is positive = bad
-altered mental status
-respiratory rate >22
-SBP <100
Systemic Inflammatory Response Syndrome (SIRS)
-generalized inflammation in organs remote from initial insult
causes of SIRS
-sepsis/microbial invasion (bacteria, fungus, viruses, parasites, etc.)
-trauma (burns, crush injuries, surgical procedures)
-abscess formation (intraabdominal/extremities_
-ischemic or necrotic tissues (vascular disease)
-post cardiac arrest
-shock states
goal of SIRS
prevent progression
what happens if SIRS progresses?
leads to Shock/MODS
SIRS criteria
-tachycardia (>90)
-tachypnea (>20)
-fever or hypothermia
-leukocytosis, leukopenia, or bandemia
-don’t need to have an infection to meet SIRS criteria
inter professional care goals
- prevention and treatment of infection
- maintenance of tissue oxygenation
- nutritional and metabolic support
- appropriate support of failing organs
what are central venous catheters?
-long flexible catheter that internally dumps contents in or near heart
-quick intervention, fast & accurate delivery of medications
why use a central line?
-long term administration of medications (chemo, ABX)
-administration of vesicant medications (vasopressors/chemo)
-provide fluid or nutrition
-complete certain tests
are femoral central lines good long term?
no, but good in emergency b/c don’t need X-ray to confirm placement
central line associated blood stream infections
-blood stream infections caused from a central line
-can lead to sepsis, SIRS, & MODS if line and site are not properly cared for
preventing CLABSIs
-insert with sterile technique
-wear clean gloves and perform hand hygiene before accessing
-change dressing every 7 days or when soiled (2Rn change)
-bathing in chlorhexidine wipes daily
-flush each port every shift
-0obtain MD order for blood draws
-change caps after each blood draw, blood administration, & daily with TPN
-use curos caps, scrub for 30 seconds
-remove central line when it’s no longer needed
