Sepsis Flashcards
What are the SIRS criteria?
- Temp > 38 or 90
3. RR > 20 or PaCO2 12,000 or
What are the criteria for severe sepsis?
Sepsis + organ dysfunction/hypoperfusion
- Hypotension
- Oliguria
- Lactic acidosis
- AMS
What is septic shock?
Sepsis + hypotension that doesn’t respond to fluids
What are the three large ideas/goals in early goal directed therapy?
- Fill the tank
- Fix the pipes
- Prime the pump
What is the most common cause of sepsis?
Bacterial infection
What is the pathogenesis of sepsis?
- Infection causes activation of inflammatory and coagulation cascades
- This spreads beyond local site of infection
- You get hypotension, hypoperfusion, coagulopathy
- Organs forced into anaerobic metabolism (lactic acidosis)
How might sepsis look different at the extremes of age?
- More likely to be hypothermic
2. Elderly less able to mount tachycardic response
What is usually the first indicator of end organ damage in sepsis?
AMS
In patients with sepsis, what should you try to obtain before giving fluids (although this shouldn’t delay administration)?
POC Lactate
In what patients with sepsis, must you be careful about fluids?
- CHF
2. Renal failure
Immediately after admin of first fluid bolus in sepsis, what should you do?
Reassess. If patient still hypotensive, new lactate > 4, or continued signs of hypoperfusion:
Start EGDT
What are the EGDT goals?
- CVP 8-12 (increase fluids to meet)
- MAP > 65 (add pressors)
- Central venous O2 sat > 70 (optimize O2 delivery: PRBC)
In sepsis, what is the lactate clearance goal?
> 10% per hour
If it is not reached:
- PRBC if HCT
What are the role of steroids in sepsis?
Becoming more limited as it does not improve overall mortality. Use only if history of prolonged steroid use or other concern for adrenal suppression.
What is the role of activated protein C in sepsis?
- Acute phase reactant that inhibits clots and promotes breakdown
- Should be given to patients with sepsis-induced organ dysfunction that are deemed to be at high risk of death
