Sepsis

Question 1

Define sepsis

Answer 1

Systemic Inflammatory Response Syndrome (SIRS) that is due to or suspected to be from infection.

Question 2

Epidemiology of Sepsis

Answer 2

• Men > Women
• nonwhite > white
• increasing incidence
• rate of sepsis due to Fungal infection increased by 207%
• Total # deathes continued to increase but in-hospital mortality rate fell, and ave length of hosp stay decreased

Question 3

Criteria for SIRS?

Answer 3

Two or more of the following findings:

1. Temp > 38*C or 90 bpm
2. Tachypnea, RR > 20
3. WBC ct > 12,000; or 10% Bands

Question 4

Noninfective causes of SIRS

Answer 4

• Surgery/trauma
• Transplant rejection
• Blood products (transfusion)

Question 5

Afebrile infections

Answer 5

• extremes of age (neonates and elderly)
• Immunocompromised
• Corticosteriod use
• NSAID/ Acetaminophen use
• CKD (odd form of immunocomp.)
• uncontroled DM
• Neuro insults (Stroke)

Question 6

Which vital sign has the most potential for flaw, and therefor to affect Dx of SIRS/Sepsis?

Answer 6

Respiratory Rate

Question 7

What distinguishes Sepsis from Severe Sepsis?

Answer 7

1. Organ Dysfunction or

2. Evidence of hypoperfusion or Hypotension

Question 8

What distinguishes Severe Sepsis from Septic shock?

Answer 8

Hypotension

- persistent despite adequate fluid resuscitation

Question 9

Clinical manifestations of sepsis

Answer 9

• Fever, tachycardia, tachypnea
• incr Minute ventilation
• mental status changes*
• N/V
• loss of appetite
• Not tolerating feeds* (food tubes) (ICU pts)
• bad prognosis

Question 10

Resuscitation goals for Sepsis?

Answer 10

1. Central Venous Press: 8-12 mmHg
2. Mean Arterial Press: > 65 mmHg
3. Urine Output: > 0.5 mL/Kg/hr
4. Central Venous 02 Sat: > 70%

• also tx the source of infection (if present)
• early antibiotics! (every hr delayed = 6.5% increase in mortality)

Question 11

T or F: You need a positive blood culture to Dx sepsis

Answer 11

False

- sepsis may occur without a positive blood culture

Question 12

What two drugs can reduce the toxins caused by bacteria?

Answer 12

1. Clindamycin

2. Linezold

Question 13

What do you give a Septic Pt to reach the resuscitation goals?

Answer 13

*Antibiotics within 1 hr and source control

1. CVP - Crystalloid or Normal Saline
2. MAP - Levophed (Vasopressor*)
3. Scv02 - Packed RBCs

Question 14

Differences btw crystalloid and normal saline

Answer 14

NS has pH of 5.4 => Hyperchloremia and metabolic acidosis

Crystalloid is more ballanced

Question 15

8 Preventive measures in Sepsis

Answer 15

1. Hand washing
2. DVT prophylaxis
3. Stress ulcer prophylaxis
4. Elevate head of bed (prevent VAP/HAP)
5. Chlorhexidine mouthwash
6. Remove foley or cath a$ap
7. target glucose