Sepsis

Question 1

What is Sepsis and the different definitions?

Answer 1

Question 2

Tell me about quick SOFA and the SIRS Criteria

Answer 2

Question 3

What are the common pathogens and sites of sepsis

Answer 3

Question 4

Normal Human Flora review

Answer 4

Question 5

Describe the pathophysiology of sepsis (1)

Answer 5

Question 6

Describe the pathophysiology of sepsis (2)

Answer 6

Question 7

What are the risk factors and complications for sepsis?

Answer 7

Question 8

What are the clinical presentations of sepsis?

Answer 8

Question 9

Tell me about initial fluid resuscitation

Answer 9

Don’t use D5W to resuscitate

so LR is the preferred choice for resuscitation even over NS

Question 10

Tell me about broad spectrum empiric IV antibiotics and some examples (1)

Answer 10

Question 11

Tell me about broad spectrum empiric IV antibiotics and MRSA/MDR gram neg. (2)

Answer 11

Question 12

Tell me about empiric antifungal therapy (1)

Answer 12

Question 13

Tell me about empiric antifungal therapy (2) Echinocandins and azoles

Answer 13

Question 14

Tell me about empiric antifungal therapy (3) polyenes

Answer 14

Question 15

Answer 15

D

Question 16

Answer 16

C & E

Question 17

Answer 17

Common sense sub theraputic and toxicities

Question 18

Answer 18

A & C

Question 19

Tell me about septic shock

Answer 19

Question 20

Tell me about vasopressor receptors and vasopressors

Answer 20

1st line is Norepi (NE) 2nd is Vasopressin but add on to reduce NE requirements never use as monotherapy

Question 21

Tell me about vasopressors vs inotropes

Answer 21

Question 22

Answer 22

C

Question 23

Tell me about directed therapy & antimicrobial duration

Answer 23

Question 24

Tell me about adjunctive hydrocortisone and supportive care

Answer 24

Question 25

Tell me about the first 3-6 hours at UCI

Answer 25

Question 26

Tell me about the sepsis standards of care at UCI

Answer 26

Question 27

Answer 27

1. **Does patient meet criteria for sepsis?** 👩‍⚕️ Yes, MS definitely meets sepsis criteria! Let's check against SIRS criteria: - Temperature: 101.8°F (>38°C) ✓ - Heart rate: 120 bpm (>90) ✓ - Respiratory rate: 26 breaths/min (>20) ✓ - WBC: 23,000/mm³ (>12,000) ✓ Plus evidence of organ dysfunction: - Low BP (88/50) and MAP (63) - Elevated lactate (4.2 mmol/L) - Altered mental status (lethargic) - Acute kidney injury (Cr 2.4 from baseline 0.9) 2. **What should be done in first 3 hours?** ⏰ The 3-hour bundle includes: - Measure lactate (already 4.2 mmol/L) - Obtain blood cultures before antibiotics - Start broad-spectrum antibiotics - Begin fluid resuscitation (30mL/kg crystalloid) - Monitor hemodynamics - Consider vasopressors if needed 3. **LR calculation for 80kg patient** 💧 Let's calculate: 30 mL/kg × 80 kg = 2400 mL of Lactated Ringers 4. **Determining antibiotics** 💊 Based on presentation: - Suspected respiratory infection (bilateral infiltrates) - Need broad-spectrum coverage - Consider: * Ceftriaxone + Azithromycin (community acquired) * Add Vancomycin if MRSA suspected * Consider local resistance patterns * Adjust based on cultures 5. **Supportive care measures** 🏥 - Oxygen therapy (SpO2 only 88%) - Continuous vital sign monitoring - Strict glucose control (currently 280 mg/dL) - Regular neurological checks - Monitor urine output - Consider nutritional support - Pain management as needed - Antipyretics for fever

Question 28

Answer 28

Fluid resuscitation 1600cc of LR add vasopressor NE if needed

Question 29

Answer 29

1)NE 1st line 2)Vasopressin add if NE is above 20 to increase vascular resistance 3)Add epinephrine if not at goal 4)Dopamine if bradycardia and low risk for arrhythmia 5)Dobutamine if patient has low cardiac output and needs increase in heart rate 6)angiotensin II as last line 7)phenylephrine for salvage therapy last line

Question 30

Answer 30

Expand gram negative coverage to meropenem as they were already on zosyn for 5 days and no change. could also be a fungus so u can add on an echinocandian like micofungin (fungocidal preffered) or fluconazole (fungostatic)

Question 30

Answer 30

Vanc and zoysn

Question 31

Answer 31

Switch patient to micafungin or increase dose of fluconazole