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Pulmonology > Sepsis > Flashcards

Sepsis Flashcards

1
Q

What is the definition of sepsis?

A

Systemic Inflammatory Response Syndrome (SIRS) due to infection (proven or suspected)

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2
Q

do you need a positive blood culture for the dx of sepsis?

A

no

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3
Q

what happened (need a number) to the rate of sepsis due to fungal organisms from 1979 to 2000?

A

the rate of sepsis due to fungal organisms increased by 207%

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4
Q

what happened to the total in-hospital mortality rate from 1979-2000?

A

it fell

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5
Q

what happened to the average length of the hospital stay from 1979-2000?

A

it decreased

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6
Q

besides aging, what is another big reason why incidence of fungal infections is increasing?

A

overuse of antibiotics - inhibit normal flora, allow Candida to grow

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7
Q

why has length of hospital stay decreased recently? (might help to remember why)

A

insurance companies are urging to get shorter length of stay

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8
Q

what diagnostic criteria does our definiton of Sepsis (SIRS + infection) lack?

A

it lacks sensitivity and specificity

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9
Q

what are the SIRS criteria?

A

two or more of the following

1) Temp >38 C or less than 36 C
2) HR greater than 90 bpm
3) Tachypnea, RR >20
4) WBC >12,000 or less than 4,000 or > 10% bands

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10
Q

what is the association of fever and sepsis?

A

most pts in whom sepsis develops do not become febrile

they do not have a robust enough immune system t

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11
Q

what are 7 examples of afebrile infections?

A

1) extremes of age
2) immunocompromised
3) corticosteroid use **
4) NSAID/acetaminophen use **
5) CKD
6) diabetes
7) neurologic insults - strokes, brain malformations

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12
Q

which vital sign is the major practical flaw in recording vital signs

A

respiratory rate (it is subjective ish - all pts are 20 b/c nurses don’t actually measure this)

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13
Q

define severe sepsis

A

sepsis + organ dysfunction or evidence of hypoperfusion or hypotension

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14
Q

define septic shock

A

sepsis-induce hypotension

persisting despite adequate fluid resuscitation

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15
Q

how do we know, how can we determine that there is hypotension, leading to end organ ischemia, in the setting of septic shock

A

measure the level of lactic acid in the blood

if there is end organ ischemia, they will be in anaerobic metabolism, so generating lactic acid

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16
Q

what does septic shock require as treatment

A

vasopressors

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17
Q

what is Muthiah’s simplistic definition of the pathogenesis of septic shock leading to death?

A

an excessive host immune response to insult/infection that causes tissue injury - shock and multiorgan failure - and death

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18
Q

what are 9 clinical manifestations of sepsis?

A

1) fever
2) tachycardia
3) tachypnea
4) increase in minute ventilation *
5) hypotension
6) mental status change*
7) nausea, vomiting
8) loss of appetite
9) ICU pts not tolerating feeds

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19
Q

what is the pathogenesis of why shock is accompanied by hypotension?

A

vasodilation is a characteristic feature of shock - this causes some hypotension b/c of pressure volume relationship
also, vessels become more leaky, and there is hypovolemia

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20
Q

which pts is the mental status change in shock most noticeable in

A

neonates and the elderly

21
Q

what is the term/buzzword for the perspective of early resuscitation that is applied to severe sepsis and septic shock regarding time frame

A

silver day

22
Q

what are the 4 goals of goal directed resuscitation? (red box, must know)

A

1) central venous pressure 8-12 mm Hg
2) mean arterial pressure >65 mm Hg
3) Urine output >0.5 mL/kg/hr
4) central venous O2 saturation >70%

23
Q

what are two other important points to add on w/ the goal directed resuscitation of a pt in sepsis

A

1) source control

2) don’t stop when you have Bacteremia - need to know where the bacteria is coming from

24
Q

we must give antibiotics early when suspected sepsis - how much does each hour delay in antibiotics increase mortality?

A 
6-7 % 
immediate ABX - 20% mortality 
1 hour delay - 27% mortality 
3 hour delay - 44%
5 hour delay - 58%
25
Q

severe sepsis with hypotension necessitates the need for what medication, and what is the side effect of this?

A

vasopressors

causes dry gangrene of extremities and digits

26
Q

what are the 4 main categories for lab work that we want to gather in suspected sepsis?

A

1) gram stain and culture of appropriate body fluids
2) blood cultures x2 - peripherally and through a vascular access device while present
3) appropriate imaging - CXR, CT scan, HIDA scan, etc
4) a good H and P will direct investigation

27
Q

do a majority of pts w/ sepsis get a positive blood culture?

A

no - most of the time will not be able to get positive culture
(bacteremia is an episodic phenomenon)

28
Q

early goal directed resuscitation…

A

saves lives

29
Q

what is the most optimal and cost effective fluid for resuscitation?

A

normal saline

30
Q

for septic shock, a pt that is already volume resuscitated, and is on vasopressors, what additional medication can you give them? (I doubt this will show up, but it is in critical care guidelines)

A

hydrocortisone

has been shown to decrease mortality

31
Q

what is a good preventive care against infection?

A

hand washing

32
Q

what is the pH of “normal saline”? what are 3 effects of this

A

nml saline pH = 5.4

1) NS - hyperchloremia and metabolic acidosis
2) alterations in renal blood flow
3) potentially important effects on immune function

33
Q

what is more desirable than normal saline for volume resuscitation

A

balanced fluids - like Ringer’s lactate

34
Q

choice of vasopressors between Levophed and Dopamine

A

Levophed is better

35
Q

For the Exam: sepsis = ?

A

SIRS + infection

36
Q

For the Exam: severe sepsis =?

A

Sepsis + organ dysfunction

37
Q

for the Exam: septic shock = ?

A

sepsis + hypotension not responding to fluid resuscitation

38
Q

For the Exam: what is the resuscitation fluid of choice?

A

crystalloids = saline + Lactate Ringer’s

39
Q

For the Exam: what does Early Goal Directed Therapy do?

A

improves mortality

40
Q

For the Exam: What are two general things for the EGDT (not the specific 4 components)

A

early antibiotics

source control

41
Q

For the Exam: who gets afebrile infections?

A

very young / old
CKD
DM
Steroid use

42
Q

For the Exam: the pathogenesis of sepsis is a considered a condition associated with what in the host?

A

profound initial immune activation

43
Q

For the Exam: what do we see elvated in the blood with sepsis?

A

Pro-inflammatory cytokine levels are elevated along with neutrophilic leukocytosis

44
Q

For the Exam: what is the criteria for SIRS (systemic inflammatory response syndrome)

A

two or more of

1) temp >38C or less than 36C
2) HR >90 bpm
3) tachypnea, RR >20
4) WBC count >12,000 or less than 4,000 or > 10% bands

45
Q

For the Exam: what are the 4 goals of EGDT?

A

1) Central venous pressure: 8-12 mm Hg
2) MAP >65 mm Hg
3) urine output >0.5 mL/kg/hr
4) central venous O2 saturation >70%

46
Q

For the Exam: what is a good surrogate for inadequate oxygen delivery?

A

lactic acid elevation - therefore a low central venous O2 sat

47
Q

For the Exam: what are 8 preventative measures in sepsis?

A

1) hand washing
2) DVT prophylaxis
3) Stress ulcer prophylaxis (H2 blocker vs PPI)
4) head of bed elevation to prevent VAP/HAP
5) Chlorhexidine mouthwash?
6) remove Foley catheter and central lines ASAP
7) early ambulation and physical therapy
8) target glucose less than 150 mg/dL

48
Q

Have your pts been FASTHUG ed?

A 
Feeds
Analgesics 
Sedation protocol 
Thromboembolism prophylaxis 
Head of bed elevated >30 deg 
Ulcer prophylaxis 
Glucose Control
49
Q

Clicker - autopsy, immunohistochemical studies in sepsis have shown which of the following cell lines to be dying?

A

lymphocytes and GI epithelial cells

Pulmonology (31 decks)

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