- fungal causes on the rise - in-hospital mortality and length of hospital stay falling

Sepsis Flashcards by Shane Hagen

What is sepsis?

systemic inflammatory response syndrome (SIRS) due to known or suspected infection

NOT a positive blood culture (aka bacteremia)

How well did you know this?

Not at all

Perfectly

Can sepsis occur without dissemination?

Yes

How well did you know this?

Not at all

Perfectly

T or F. Bacteremia can be tranisent

T. Even is normal conditions (i.e. straining to go No. 2) you can get some

How well did you know this?

Not at all

Perfectly

How common is sepsis?

leading cause of death in critically ill patients (210,000 deaths/year)

How well did you know this?

Not at all

Perfectly

Patient population for sepsis?

Nonwhite persons, and men (because androgens are more pro-inflammatory than estrogens)

How well did you know this?

Not at all

Perfectly

What group of bacteria are the most common cause of sepsis?

gram +

How well did you know this?

Not at all

Perfectly

T or F. Early mobilization is good even in sepsis

How well did you know this?

Not at all

Perfectly

Trends with sepsis

fungal causes on the rise

- in-hospital mortality and length of hospital stay falling

How well did you know this?

Not at all

Perfectly

What is ‘severe’ sepsis defined as?

sepsis + organ failure

How well did you know this?

Not at all

Perfectly

What is ‘septic shock’ defined as?

severe sepsis plus refractory hypotension which persists despite giving 30cc/kg of fluid and require vasopressors

How well did you know this?

Not at all

Perfectly

How is sepsis defined?

life-threatening organ dysfunction cause by a dysregulated host response to infection

How well did you know this?

Not at all

Perfectly

What NON-infectious etiologies can cause SIRS?

pancreatitis
burns
trauma
organ rejection

How well did you know this?

Not at all

Perfectly

How is SIRS defined? criteria

two or more of:

Temp over 38C or under 36C
Heart rate 90+ bpm
Tachypnea, RR over 20
WBC over 12k or less than 4k (OR 10+%bands)

How well did you know this?

Not at all

Perfectly

What are some noninfectious causes of SIRS?

blood transfusion
surgery
many others

How well did you know this?

Not at all

Perfectly

T or F. Many patients with sepsis do not become febrile

How well did you know this?

Not at all

Perfectly

What are some patient populations that can have afebrile SIRS?

extreme age
immunocompromised
corticosteroids
NAIDS/acteaminophen use
CKD (especially on dialysis)
Diabetes uncontrolled
Strokes/brain malfunction (hypothalamus damage)

need an immune response!

How well did you know this?

Not at all

Perfectly

What is the purpose of fever?

enhances immune system ability to handle infection (phagocytosis, Ab binding is more optimal)

How well did you know this?

Not at all

Perfectly

Sepsis = what?

SIRS + infection

What causes hypotension in septic shock?

vasodilation and increased permeability

What kind of shock is septic shock?

distributive

Ex. of obstructive shock

pulmonary embolism

Why would you see tachycardia in SIRS?

reflex of hypotension

T or F. Sepsis can be associated with mental status change

T. Poor prognosis

Vomiting is one of the very first signs of infection in which patients?

kids

In the ICU, another manifestation of sepsis is not tolerating feed well. How does this manifest?

Gastric residuals- this is a quantifier that can be measured by a nurse and if the food is going where it should be, this should be very low

What is the 'silver day' of sepsis?

notion that early treatment makes for the best prognosis

What are some of the goals of fluid directed treatment of sepsis?

- central venous pressure of 8-12 mm Hg - MAP greater than 65 mm Hg - Urine output more than 0.5ml/kg/hr - central venous O2 saturation over 70%

What is a normal SvO2?

65-70% and decreased when oxygen delivery is inadequate

SvO2 can be corrected in sepsis by doing what?

optimizing Hb and/or CO

What is another way to test whether oxygen is being delivered as intended?

lactic acid measurement

Each hour delay in ABX increases mortality by ____%

6-7

What kinds of lab work is needed before starting ABX in sepsis?

- 2 sets of blood culture - CBC - CXR, CT scan

What are two ABX known to decrease toxin production?

Clindamycin and Linezolid

What fluids are used in sepsis?

Normal saline (albumin will work the same but way more expensive) or a crystalite

Why is called 'normal' saline?

it is isotonic

What is the pH of normal saline?

5.4, so more equals a higher risk of hyperchloremia and metabolic acidosis

AEs of normal saline?

- alterations in renal blood flow - effect immune function balanced fluids avoid these biochemical effects

Balanced fluids (sodium acetate/Lactoringer's provides a better response for sepsis. How?

Balancing pH as well as being isotonic

Why cant you just use Lactoringer's saline?

potassium levels may start to increase

What are some choices of vasopressor?

-Levophed better than Dopamine at 20mics/min of Levophed, add vasopressin

Preventive measures in sepsis

- hand washing - DVT prophylaxis - stress ulcer prophylaxis - head of the bed elevation - chlorhexidine mouthwash - remove foley cath and central lines ASAP - early ambulation - target glucose less than 150 mg/dL

Why do septic patients have hyperglycemia?

increased catecholamines cause increased gluconeogenesis and insulin resistance

Autopsy/Immunohistochemical studies of sepsis have shown which cell lines to be dying?

lymphocytes and GI epithelial cells