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Pulmonary Week 3 > Sepsis > Flashcards

Sepsis Flashcards

1
Q

What is sepsis?

A

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

NOT a positive blood culture (aka bacteremia)

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2
Q

Can sepsis occur without dissemination?

A

Yes

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3
Q

T or F. Bacteremia can be tranisent

A

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

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4
Q

How common is sepsis?

A

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

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5
Q

Patient population for sepsis?

A

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

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6
Q

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

A

gram +

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7
Q

T or F. Early mobilization is good even in sepsis

A

T.

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8
Q

Trends with sepsis

A
  • fungal causes on the rise

- in-hospital mortality and length of hospital stay falling

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9
Q

What is ‘severe’ sepsis defined as?

A

sepsis + organ failure

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10
Q

What is ‘septic shock’ defined as?

A

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

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11
Q

How is sepsis defined?

A

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

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12
Q

What NON-infectious etiologies can cause SIRS?

A
  • pancreatitis
  • burns
  • trauma
  • organ rejection
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13
Q

How is SIRS defined? criteria

A

two or more of:

  1. Temp over 38C or under 36C
  2. Heart rate 90+ bpm
  3. Tachypnea, RR over 20
  4. WBC over 12k or less than 4k (OR 10+%bands)
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14
Q

What are some noninfectious causes of SIRS?

A
  • blood transfusion
  • surgery
  • many others
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15
Q

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

A

T.

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16
Q

What are some patient populations that can have afebrile SIRS?

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

need an immune response!

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17
Q

What is the purpose of fever?

A

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

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18
Q

Sepsis = what?

A

SIRS + infection

19
Q

What causes hypotension in septic shock?

A

vasodilation and increased permeability

20
Q

What kind of shock is septic shock?

A

distributive

21
Q

Ex. of obstructive shock

A

pulmonary embolism

22
Q

Why would you see tachycardia in SIRS?

A

reflex of hypotension

23
Q

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

A

T. Poor prognosis

24
Q

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

A

kids

25
Q

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

A

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

26
Q

What is the ‘silver day’ of sepsis?

A

notion that early treatment makes for the best prognosis

27
Q

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

A
  • 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%
28
Q

What is a normal SvO2?

A

65-70% and decreased when oxygen delivery is inadequate

29
Q

SvO2 can be corrected in sepsis by doing what?

A

optimizing Hb and/or CO

30
Q

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

A

lactic acid measurement

31
Q

Each hour delay in ABX increases mortality by ____%

A

6-7

32
Q

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

A
  • 2 sets of blood culture
  • CBC
  • CXR, CT scan
33
Q

What are two ABX known to decrease toxin production?

A

Clindamycin and Linezolid

34
Q

What fluids are used in sepsis?

A

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

35
Q

Why is called ‘normal’ saline?

A

it is isotonic

36
Q

What is the pH of normal saline?

A

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

37
Q

AEs of normal saline?

A
  • alterations in renal blood flow
  • effect immune function

balanced fluids avoid these biochemical effects

38
Q

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

A

Balancing pH as well as being isotonic

39
Q

Why cant you just use Lactoringer’s saline?

A

potassium levels may start to increase

40
Q

What are some choices of vasopressor?

A

-Levophed better than Dopamine

at 20mics/min of Levophed, add vasopressin

41
Q

Preventive measures in sepsis

A
  • 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
42
Q

Why do septic patients have hyperglycemia?

A

increased catecholamines cause increased gluconeogenesis and insulin resistance

43
Q

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

A

lymphocytes and GI epithelial cells

Pulmonary Week 3 (18 decks)

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