Sepsis

Question 1

What are the three criteria for severe sepsis?

Answer 1

1. suspected or actual infection
2. two SIRS criteria
3. one new organ dysfunction

Question 2

SIRS criteria (criteria 2)

Answer 2

• Temp >38.3C (101F) OR <36.0C (96.8F)
• HR >90
• Resp Rate >20
• WBC >12,000 OR <4,000 OR >10% bands

Question 3

Abn labs that show organ dysfunction (criteria 3)

Answer 3

• SBP <90 OR MAP <65
• Lactate >2.0
• Acute need for BiPAP/Vent
• Cr >2.0 (non-ESRD)
• Bilirubin >2.0
• INR >1.5 or PTT >60
• Platelets <100,000

Question 4

What 5 things do you do when someone qualifies for severe sepsis?

Answer 4

1. Get an initial lactate
2. Blood cultures
3. Antibiotics: broad spectrum or based on culture data, after blood cultures (goal <1 hr, must be <3 hrs)
4. IV fluids: NS or LR (30mL/kg, but fluids only required if lactate _>4 or single SBP <90 or MAP <65)
5. Repeat lactate: ED repeats lactate w/in 6 hrs (only if initial lactate >2)

Question 5

Septic Shock Criteria

Answer 5

Severe sepsis criteria

PLUS

SBP <90 OR MAP <65 after initial IV fluid
OR
Initial lactate _>4

Question 6

What additional actions to take when Septic Shock Criteria are met?

Answer 6

1. IV fluids: 30mL/kg of NS or LR, if not already done (w/in 3hrs)
2. Vasopressor: for SBP <90 or MAP <65 occurring after 30mL/kg IV fluid infused (w/in 6 hrs)
3. “Sepsis Focused Exam Performed”: document time of exam after fluid bolus started (w/in 6 hrs)
   a. All 4 vital signs, cardiopulmonary exam, skin color, capillary refill, and peripheral pulses

Question 7

What are the top 3 leading causes of sepsis in descending order?

Answer 7

1. Pneumonia
2. Intra-abdominal infections
3. Urinary tract infections