Sepsis Flashcards
What is sepsis?
systemic inflammatory response syndrome (SIRS) due to known or suspected infection
NOT a positive blood culture (aka bacteremia)
Can sepsis occur without dissemination?
Yes
T or F. Bacteremia can be tranisent
T. Even is normal conditions (i.e. straining to go No. 2) you can get some
How common is sepsis?
leading cause of death in critically ill patients (210,000 deaths/year)
Patient population for sepsis?
Nonwhite persons, and men (because androgens are more pro-inflammatory than estrogens)
What group of bacteria are the most common cause of sepsis?
gram +
T or F. Early mobilization is good even in sepsis
T.
Trends with sepsis
- fungal causes on the rise
- in-hospital mortality and length of hospital stay falling
What is ‘severe’ sepsis defined as?
sepsis + organ failure
What is ‘septic shock’ defined as?
severe sepsis plus refractory hypotension which persists despite giving 30cc/kg of fluid and require vasopressors
How is sepsis defined?
life-threatening organ dysfunction cause by a dysregulated host response to infection
What NON-infectious etiologies can cause SIRS?
- pancreatitis
- burns
- trauma
- organ rejection
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)
What are some noninfectious causes of SIRS?
- blood transfusion
- surgery
- many others
T or F. Many patients with sepsis do not become febrile
T.
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!
What is the purpose of fever?
enhances immune system ability to handle infection (phagocytosis, Ab binding is more optimal)
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
