Sepsis Flashcards
Types of Organ Dysfunction seen in Sepsis
CNS
Altered consciousness
Confusion
Types of Organ Dysfunction seen in Sepsis
Respiratory
Tacypnea
Decreased PaO2
Decreased P/F ratio
Types of Organ Dysfunction seen in Sepsis
Hepatic
Jaundice
Increased Liver enzymes
Decreased albumin
Types of Organ Dysfunction seen in Sepsis
Metabolic
Metabolic acidosis
Increased lactate level
Decreased Lactate clearance
Types of Organ Dysfunction seen in Sepsis
Cardiovascular
Tachycardia
Hypotension
Altered CVP & PAOP
Types of Organ Dysfunction seen in Sepsis
Renal
Oliguria
Anuria
Increased Creatinine
Types of Organ Dysfunction seen in Sepsis
Hematologic
Decreased platelets
Increased coags
Decreased protein C
Increased D-dimer
Score to assess for organ dysfunction w/n sepsis?
SOFA
An Initial SOFA score of < 9 indicates what predicted mortality?
<33%
An Initial SOFA score of > 11 indicates what predicted mortality?
95%
Sepsis is defined as what?
SOFA >/= 2+ suspected or known infection
Septic shock is what?
Blood lactate > what?
Hypotension that persists when?
2mmol/L despite volume resuscitation
after fluid resuscitation & requires vasopressors
Most common sources for sepsis in the elderly are?
Respiratory & Urinary
Elderly Clinical Presentation often includes?
Febrile response may be blunted in up to 47% of pts
AMS/Delirium
Weakness
Anorexia
Falls
Urinary incontinence
For early Identification use what screening tools?
SIRS, NEWS or MEWS
A lactate of > 4mmol w/ metabolic acidosis suggests what?
tissue hypoxia
What measurement needs to be repeated to evaluate if sepsis therapy is effective & if patient is improving?
Lactate
Sepsis will morph & change during its course… begins like hypovolemia
W/ a BP of 102/52, Pulse of 108 what will SV, CO and ScvO2 look like?
Lower
SV will be 44 (<50-100)
CO will be around 4.75
and ScvO2 will be around 0.37
Later Sepsis changes from hypovolemia to hyperdynamic
W/ a BP of 100/56 and Pulse of 104 what will SV, CO and ScvO2 look like?
Higher
SV 105
CO 10.9
ScvO2 0.87
Fluid Responsiveness is represented as what?
increase in SV or CO by 10-15% after 500 ml Bolus of crystalloid
In the case of presence of shock what is the initial treatment?
Urgent fluid bolus
If after an urgent fluid bolus there is the persistence of shock what is the next step?
If the patient is fluid responsive assess them for risk of fluid overload
If they are not fluid responsive, stop the fluid
IF sepsis is present, what 4 things need to be done?
Obtain blood or site cultures
Obtain Lactate
Source Control
Initiate antibiotics
If organ failure is present, or increased lactate do what?
five 30ml/kg of fluids
