Sepsis

Question 1

What are the SIRS criteria?

Answer 1

temp over 100.4 F or less than 96.8 (36-38 C)

HR over 90

RR over 20 OR PaCO2 less than 32 mmHg

WBC>12,000 or <4,000 or >10% immature bands

Question 2

SIRS + Infection = ___

Answer 2

sepsis

Question 3

What puts someone in the severe sepsis cateogy?

Answer 3

sepsis with induced-organ dysfunction or tissue hypo-perfusion

Question 4

What are the end-organ dysfunction definition criteria?

Answer 4

SBP <90 or MAP <70 or SBP decrease >40 mmHg

Cr >2.0 or UOP <0.5 ml/kg/hr for >2 hrs

Bili >2

Plt <100,000

Coagulopathy

lactate >2

Question 5

What is the definition of septic shock?

Answer 5

sepsis with persistently low BP despite fluid administration (30 mL/kg)

Question 6

What makes a lactate go up in sepsis?

Answer 6

anaerobic glycolysis during periods of insufficient oxygen delivery

Question 7

What are the four things you must do for the three-hour bundle the sepsis quality measure?

Answer 7

1. lactate measurement
2. blood cultures before starting abx
3. administratin of broad spec ABx
4. administration of 30 ml/kg IV crystalloid for hypotension or lactate over 4

Question 8

What are the three things you must do for the 6 hour bundle in the sepsis quality measure?

Answer 8

1. give vasopressors for hypotension that doesn’t respond to fluids to get MAP over 65
2. reassess and document volume status after fluid administration
3. repeat lactate for patients with initial lactate over 4