sepsis Flashcards
systemic inflammatory response (SIRS) criteria sens/ spec
These criteria are well known to have poor sensitivity and specificity for the presence of sepsis syndromes.
systemic inflammatory response (SIRS) criteria
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
systemic inflammatory response (SIRS) criteria (PaCO 2)
(PaCO 2) of less than 32 mm Hg
systemic inflammatory response (SIRS) criteria fever
Fever > 38°C (100.4°F) or less than 36°C (96.8°F)
systemic inflammatory response (SIRS) criteria WBC
WBC (>12,000/µL or < 4,000/µL or >10% immature band forms)
Sepsis is defined as
a patient who has a potential infectious cause for the SIRS response.
A patient is said to have severe sepsis if
meet criteria for sepsis and have sepsis-induced organ dysfunction or tissue hypo perfusion.
Sepsis-induced organ dysfunction or tissue hypo perfusion examples
hypotension
kidney failure,
AMS
elevated lactate > than 4 mmol/L
The Centers for Medicare and Medicaid Services (CMS) define end-organ dysfunction by the following criteria
Blood Pressure
(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
CMS end-organ dysfunction creatinine
Creatinine > 2.0 mg/dl (176.8 mmol/L) or Urine Output < 0.5 ml/kg/hour for > 2 hours,
CMS end-organ dysfunction bilirubin
Bilirubin > 2 mg/dl (34.2 mmol/L),
CMS end-organ dysfunction plts
Platelet count < 100,000,
CMS end-organ dysfunction co-ags
Coagulopathy (INR >1.5 or aPTT >60 secs),
CMS end-organ dysfunction lactate
Lactate > 2 mmol/L (18.0 mg/dl)
Septic shock is defined as
persistently low BP despite the fluid
~ 30 mL/kg.
__________ is the primary method of risk stratification for patients presenting with sepsis.
Lactate
Ideal testing–> POC testing or an arterial blood gas machine based in the ED. Old blood does not work well
Hypoperfusion of end organs is typically defined as an elevated lactate of?
lactate ≥ 2 mmol/L
Early goal directed therapy (EGDT) steps
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)
Required sepsis bundles- Three Hour Bundle
Lactate
Blood cultures (before abx)
broad spectrum abx
30 ml/kg IV crystalloid for hypotension or lactate ≥ 4 mmol/L.
Required sepsis bundles
Six hour Bundle
- 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
IV fluids oin shock- providers should use caution in patients with
ESRD
CHF
end stage liver disease
*aggressive fluid resuscitation deleterious
_________ is a necrotizing fasciitis of the male genitalia that originates from the skin, urethra, or rectum
Fournier gangrene
Septic arthritis basics
- an infection of a joint space
- Staphylococcus aureus is predominant
- pathogen for all age groups
- most commonly the knee
Septic arthritis diagnostic test
Arthrocentesis with joint fluid
WBC count > 50,000/μL with > 75% granulocytes.
thrombotic thrombocytopenic purpura (TTP) pentad
mnemonic FAT RN
- fever
- hemolytic anemia
- thrombocytopenia,
- renal failure
- neurologic change (waxing and waning AMS)
Ludwig Angina
life-threatening cellulitis of the connective tissue of the floor of the mouth and neck that begins in the submandibular space
Centor Criteria for strep
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
