sepsis

Question 1

systemic inflammatory response (SIRS) criteria sens/ spec

Answer 1

These criteria are well known to have poor sensitivity and specificity for the presence of sepsis syndromes.

Question 2

systemic inflammatory response (SIRS) criteria

Answer 2

Fever > 38°C (100.4°F) or< 36°C (96.8°F)
HR> 90
RR> 20 or PaCO 2 of less than 32 mm Hg
WBC (>12,000/µL or < 4,000/µL or >10% immature band forms)

*Need 2 or more

Question 3

systemic inflammatory response (SIRS) criteria (PaCO 2)

Answer 3

(PaCO 2) of less than 32 mm Hg

Question 4

systemic inflammatory response (SIRS) criteria fever

Answer 4

Fever > 38°C (100.4°F) or less than 36°C (96.8°F)

Question 5

systemic inflammatory response (SIRS) criteria WBC

Answer 5

WBC (>12,000/µL or < 4,000/µL or >10% immature band forms)

Question 6

Sepsis is defined as

Answer 6

a patient who has a potential infectious cause for the SIRS response.

Question 7

A patient is said to have severe sepsis if

Answer 7

meet criteria for sepsis and have sepsis-induced organ dysfunction or tissue hypo perfusion.

Question 8

Sepsis-induced organ dysfunction or tissue hypo perfusion examples

Answer 8

hypotension
kidney failure,
AMS
elevated lactate > than 4 mmol/L

Question 9

The Centers for Medicare and Medicaid Services (CMS) define end-organ dysfunction by the following criteria
Blood Pressure

Answer 9

(SBP)<90 mm Hg or mean arterial pressure <70 mm Hg or a SBP decrease >40 mm Hg or <2 SD
below normal for age or known baseline

Question 10

CMS end-organ dysfunction creatinine

Answer 10

Creatinine > 2.0 mg/dl (176.8 mmol/L) or Urine Output < 0.5 ml/kg/hour for > 2 hours,

Question 11

CMS end-organ dysfunction bilirubin

Answer 11

Bilirubin > 2 mg/dl (34.2 mmol/L),

Question 12

CMS end-organ dysfunction plts

Answer 12

Platelet count < 100,000,

Question 13

CMS end-organ dysfunction co-ags

Answer 13

Coagulopathy (INR >1.5 or aPTT >60 secs),

Question 14

CMS end-organ dysfunction lactate

Answer 14

Lactate > 2 mmol/L (18.0 mg/dl)

Question 15

Septic shock is defined as

Answer 15

persistently low BP despite the fluid

~ 30 mL/kg.

Question 16

__________ is the primary method of risk stratification for patients presenting with sepsis.

Answer 16

Lactate

Ideal testing–> POC testing or an arterial blood gas machine based in the ED. Old blood does not work well

Question 17

Hypoperfusion of end organs is typically defined as an elevated lactate of?

Answer 17

lactate ≥ 2 mmol/L

Question 18

Early goal directed therapy (EGDT) steps

Answer 18

1- arterial line and central venous catheter 2- titration of IV fluids –> CVP 8-12 mm Hg 3- vasopressors–> MAP >65
4- measurements of central venous o2 (if low, give blood)

Question 19

Required sepsis bundles- Three Hour Bundle

Answer 19

Lactate
Blood cultures (before abx)
broad spectrum abx
30 ml/kg IV crystalloid for hypotension or lactate ≥ 4 mmol/L.

Question 20

Required sepsis bundles

Six hour Bundle

Answer 20

• vasopressors for ↓ BP that does not respond to fluids for MAP ≥ 65 mm Hg
• Reassess volume status after fluid administration for ↓ BP does not respond to fluids or lactate ≥ 4 mmol/L
• Repeat lactate measurement for patients with initial lactate ≥ 4 mmol/L

Question 21

IV fluids oin shock- providers should use caution in patients with

Answer 21

ESRD
CHF
end stage liver disease

*aggressive fluid resuscitation deleterious

Question 22

_________ is a necrotizing fasciitis of the male genitalia that originates from the skin, urethra, or rectum

Answer 22

Fournier gangrene

Question 23

Septic arthritis basics

Answer 23

• an infection of a joint space
• Staphylococcus aureus is predominant
• pathogen for all age groups
• most commonly the knee

Question 24

Septic arthritis diagnostic test

Answer 24

Arthrocentesis with joint fluid

WBC count > 50,000/μL with > 75% granulocytes.

Question 25

thrombotic thrombocytopenic purpura (TTP) pentad

Answer 25

mnemonic FAT RN

• fever
• hemolytic anemia
• thrombocytopenia,
• renal failure
• neurologic change (waxing and waning AMS)

Question 26

Ludwig Angina

Answer 26

life-threatening cellulitis of the connective tissue of the floor of the mouth and neck that begins in the submandibular space

Question 27

Centor Criteria for strep

Answer 27

Presence of tonsillar exudates +1
cervical lad +1
Fever by history +1
Absence of cough +1
Age <15 years +1
Age >45 years −1

> 4 points= treat
2-3 = culture