Sepsis

Question 1

septic shock management

Answer 1

correct underlying cause, fluid resuscitation, vasopressors, inotropes, corticosteroids

Question 2

identifying sepsis: qSOFA score
(rapid bedside score)

Answer 2

at least 2 of the following:
-SBP <100 mmHg
-RR >22
-altered mentation

Question 3

identifying sepsis: SIRS criteria

Answer 3

at least 2 of the following:
-temp >38* or <36*
-HR >90
-RR >20
-WBC >12 or <4

Question 4

crystalloids

Answer 4

-LR/NS
-30 mL/kg over 15-30 min
-1L = 250 mL intravascular volume

Question 5

colloids

Answer 5

-albumin
-5% for fluid resuscitation
-25% for fluid mobilization
-1L = 500-1000mL intravascular

Question 6

pharmacotherapy of septic shock

Answer 6

-initate vasoactive agents when MAP <65
-arterial line should be placed if possible
-CVC required for admin

Question 7

vasopressors

Answer 7

norepinephrine, epinephrine, dopamine, phenylephrine, vasopressin, angiotensin II

Question 8

inotropes

Answer 8

dobutamine, milrinone

Question 9

norepinephrine

Answer 9

-1st line

Question 10

vasopressin

Answer 10

added if patient has inadequate MAP while on norepi

Question 11

epinephrine

Answer 11

added if BP goals not achieved with norepinephrine and vaso

Question 12

dobutamine

Answer 12

added when patients require cardiac output support

Question 13

hydrocortisone (+fludrocortisone)

Answer 13

-added after poor response to fluids and vasopressors
-cortisol improves physiologic response to sepsis

Question 14

summary

Answer 14

-norepi > vasopressin
-avoid dopamine
-steroids with refractory shock
-target MAP >/ 65