Sepsis

Question 1

Types of Organ Dysfunction seen in Sepsis
CNS

Answer 1

Altered consciousness
Confusion

Question 2

Types of Organ Dysfunction seen in Sepsis
Respiratory

Answer 2

Tacypnea
Decreased PaO2
Decreased P/F ratio

Question 3

Types of Organ Dysfunction seen in Sepsis
Hepatic

Answer 3

Jaundice
Increased Liver enzymes
Decreased albumin

Question 4

Types of Organ Dysfunction seen in Sepsis
Metabolic

Answer 4

Metabolic acidosis
Increased lactate level
Decreased Lactate clearance

Question 5

Types of Organ Dysfunction seen in Sepsis
Cardiovascular

Answer 5

Tachycardia
Hypotension
Altered CVP & PAOP

Question 6

Types of Organ Dysfunction seen in Sepsis
Renal

Answer 6

Oliguria
Anuria
Increased Creatinine

Question 7

Types of Organ Dysfunction seen in Sepsis
Hematologic

Answer 7

Decreased platelets
Increased coags
Decreased protein C
Increased D-dimer

Question 8

Score to assess for organ dysfunction w/n sepsis?

Answer 8

SOFA

Question 9

An Initial SOFA score of < 9 indicates what predicted mortality?

Answer 9

<33%

Question 10

An Initial SOFA score of > 11 indicates what predicted mortality?

Answer 10

95%

Question 11

Sepsis is defined as what?

Answer 11

SOFA >/= 2+ suspected or known infection

Question 12

Septic shock is what?
Blood lactate > what?
Hypotension that persists when?

Answer 12

2mmol/L despite volume resuscitation
after fluid resuscitation & requires vasopressors

Question 13

Most common sources for sepsis in the elderly are?

Answer 13

Respiratory & Urinary

Question 14

Elderly Clinical Presentation often includes?

Answer 14

Febrile response may be blunted in up to 47% of pts
AMS/Delirium
Weakness
Anorexia
Falls
Urinary incontinence

Question 15

For early Identification use what screening tools?

Answer 15

SIRS, NEWS or MEWS

Question 16

A lactate of > 4mmol w/ metabolic acidosis suggests what?

Answer 16

tissue hypoxia

Question 17

What measurement needs to be repeated to evaluate if sepsis therapy is effective & if patient is improving?

Answer 17

Lactate

Question 18

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?

Answer 18

Lower
SV will be 44 (<50-100)
CO will be around 4.75
and ScvO2 will be around 0.37

Question 19

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?

Answer 19

Higher
SV 105
CO 10.9
ScvO2 0.87

Question 20

Fluid Responsiveness is represented as what?

Answer 20

increase in SV or CO by 10-15% after 500 ml Bolus of crystalloid

Question 21

In the case of presence of shock what is the initial treatment?

Answer 21

Urgent fluid bolus

Question 22

If after an urgent fluid bolus there is the persistence of shock what is the next step?

Answer 22

If the patient is fluid responsive assess them for risk of fluid overload
If they are not fluid responsive, stop the fluid

Question 23

IF sepsis is present, what 4 things need to be done?

Answer 23

Obtain blood or site cultures
Obtain Lactate
Source Control
Initiate antibiotics

Question 24

If organ failure is present, or increased lactate do what?

Answer 24

five 30ml/kg of fluids