Sepsis

Question 1

Indicators for improvement with septic shock?

Answer 1

• Arterial blood gases (pH, PaO2, and PaCO2) within the normal range

• Maintenance of a urine output of ≥0.5 mL/kg/hr

• Maintenance of mean arterial blood pressure ≥65 mm Hg

• Absence of multiple organ dysfunction syndrome (MODS)

• Capillary refill <3 seconds

• Extremities warm without mottling

Question 2

What to do within 1 hr after recognizing sepsis?

Answer 2

1. Measure lactate level.
2. Obtain blood cultures before administering antibiotics.
3. Administer broad-spectrum antibiotics.
4. Begin rapid administration of 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.
5. Apply vasopressors if hypotensive during or after fluid resuscitation to maintain a mean arterial pressure ≥65 mm Hg.

Question 3

S+S of sepsis (values)?

Answer 3

core temp >38C or <36C, HR >90, RR >20, UO< 0.5ml/kg/hr x2hrs, BP <90/<70, lactate >1 mmol/L, WBC >12 or <4.

Question 4

What dx to do for sepsis?

Answer 4

Look at lactate level through blood work or ABGs, collect blood cultures before starting antibiotics, and administer board spectrum antibiotics

Question 5

What is sepsis?

Answer 5

Extreme response to infection that causes tissue damage, organ failure, and death.

Question 6

What changes occur with sepsis?

Answer 6

Change in mental status, impaired gas exchange, and impaired perfusion.

Question 7

Sepsis in older adults signs?

Answer 7

It’s developed easier. identified by altered mental status, lethargy, agitation, dizzy, weakness, loose appetite, dehydration, incontinency, tachypnea (older adults don’t always meet SIRS criteria- fever and tachycardia)

Question 8

Lab values for sepsis?

Answer 8

Increasing lactate level, normal/low WBC, rising procalcitonin level

Question 9

What is SIRS?

Answer 9

Stands for systemic inflammatory response syndrome. It causes widespread inflammation as bacteria increases

Question 10

What is septic shock?

Answer 10

Subset of sepsis and associated with higher risk of death. Has 2 phases- warm and cold shock. It identified in patients who require vasopressor therapy to maintain MAP of 65mmHg at least and have serum lactate level >2mmol/L.

Question 11

2 phases of septic shock?

Answer 11

1. Warm shock- early phase, there’s low systemic vascular resistance and normal/increased CO with warm extremities and reduction in cap refill
2. Cold shock- This stage is irresistible. Called late phase, peripheral vascular resistance increases, low CO with cold extremities, delayed cap refill, organs can fail, poor clotting

Question 12

Conditions that can lead to sepsis?

Answer 12

Malnutrition, age 80+, diabetes, CKD, HIV/AIDS, alcoholism, infection, cancer, exposure to invasive procedure, large/open wounds, immunosuppression

Question 13

What is MODS?

Answer 13

Multiple organ dysfunction syndrome. It’s progressive organ dysfunction in 2 or more systems that require medical intervention. This happens when septic shock progresses

Question 14

What is DIC (disseminated intravascular coagulation)?

Answer 14

occurs as result of excessive clotting and forms thousands of small clots in capillaries of liver/brain/kidney/heart/spleen, it reduced perfusion and gas exchange, petechiae and ecchymoses can occur

Question 15

True or false: need to detect sepsis early before it progresses to septic shock

Answer 15

True