Sepsis Flashcards
What is systemic inflammatory response syndrome?
Uncoordinated and exaggerated responses of the body to inflammation caused by noninfectious cause
What is sepsis?
SIRS + infection = SEPSIS
What is severe sepsis?
Acute organ dysfunction secondary to documented suspected infection.
What is septic shock?
Severe sepsis with hypotension or hypoperfusion that is not corrected with fluid resuscitation
Inadequate blood/oxygen supply to meet tissue demand!
What is included in the sepsis spectrum?
SIRS
sepsis
severe sepsis
septic shock
SIRS criteria?
2 or more of the following?
- high or low temp
- HR >90bpm
- RR >20 or
- WBC >12,000 or <4000
Dx criteria for sepsis?
SAME as SIRS:
2 or more of the following?
- high or low temp
- HR >90bpm
- RR >20 or
- WBC >12,000 or <4000
++ infection
signs/ labs seen in severe sepsis?
Elevated lactate >2 Acute kidney injury decreased UOP Creatinine >2 or increased from baseline) Acute lung injury Bilirubin >2 mg/dl Plts <100K INR >1.5 (auto-anticoagulated)
How much fluid should you give to a pt in septic shock?
30 ml/kg crystalloids is considered adequate volume (initially)
What is multiple organ dysfunction syndrome?
Progressive organ dysfunction/failure where homeostasis cannot be maintained without intervention.
ex. ARDS, liver failure, etc.
How does sepsis happen?
Imbalance btwn supply and demand of oxygen
Describe norm. inflammatory response
Local and contained response to infection or injury
Inflamed/injured tissue release mediators(Histamine, Cytokines,
Prostaglandins)
The endothelium recruits neutrophils
What can happen after inflammatory response?
tipping of the scale!
when proinflammtory cells outnumber anti-inflammatory cells
profound vasodilation is the result
What are the 3 phases of SIRS/sepsis?
1: typical insult > balance response of pro-inflammatory and anti-inflammatory responses
2: Size and/or number of insults increases > imbalanced response
3: multi organ dysfunc
Those at increased risk for sepsis?
Elderly Immunocompromised Chronic illness Malignancy Genetic factors
sepsis can cause…
multi organ failure!!
What are some of the systemic effects of sepsis?
cardiac, vascular, lungs, gut, liver failure, renal failure, neuro dysfunc.
What does the surviving sepsis campaign use?
sepsis bundles to reduce mortality
recommend screening all potentially infected seriously ill pts
SSC bundle- what should be completed in first 3 hours?
measure lactate
obtain blood cultures
give broad spec. abx
administer crystalloid for hypotension or lactate > 4
According to SCC bundle what should be done within 6 hours?
Give vasopressors (to maintain MAP)–> norepinephrine
If arterial hypotension after fluids or initial lactate > 4
- measure CVP
- measure CV oxygen saturation
recheck lactate
Primary work up for sepsis?
CBC [WBC <4 or >12] Electrolytes with BUN/Creatinine Lactate [>2] PT/INR [INR >1.5] Liver Function Tests (including bilirubin) [Bili>2] \+/- Procalcitonin \+/- ABGs
Secondary workup for sepsis?
UA
blood cultures
CXR
rapid flu
tertiary work up for sepsis?
depends on what you think the cause is
possible: LP, MRI/CT, echo
What does elevated lactate indicate?
That we are switching from aerobic to anaerobic respiration due to decreased tissue perfusion
Initial resuscitation goals? *
CVP 8-12
MAP >65mmHg
UOP >0.5
SVO2 >70%
How many liters of IV fluids are required to adequately perform fluid resuscitation?
3
How do we monitor hemodynamics?
arterial line
central venous cath
Examples of central venous caths?
PICC line, subclavian, IJ cath, femoral cath
Tx for sepsis
-empiric abx within first hour!
(consider fungal and viral coverage for high risk pts)
- source control ASAP (ex. choleycystectomy)
- fluid resuscitation
- vasopressors (norepinephrine 1st line)
+/- Steroids
Goal for use of vasopressors?
maintain MAP >65mmHg
1st choice: Norepinephrine, can add vasopressin
(epi can also be used)
Why would you give steroids in septic shock? (stress dosing- high dose burst) What can be used?
do to possible underlying adrenal insufficiency
IV hydrocortisone
-taper once BP improved
Goal blood glucose in sepsis pts?
<180
monitor Q1-2 hours
tx hyperglycemia with sliding scale insulin regimen
Other possible tx for septic pts admitted to the hospital?
GI: PPI or H2 blocker, prevents stress ulcers
DVT prophylaxis: heparin
