sepsis

Question 1

SIRS Criteria ( > 2)

Answer 1

• Temperature > 38 C < 36 C
• Heart rate > 90 bpm
• Respiratory rate > 20 /min or a PaCO2 < 32 mmHg
• White blood cell count >12,000 / cu mm or < 4,000 /cu mm, or > 10 bands

Question 2

SIRS Definitons

Answer 2

• Bacteremia: bacteria in blood
• Harmful systemic response: 2 or more (fever or hypothermia,
tachypnea, tachycardia, leukocytosis)
• Sepsis (severe sepsis): systemic response PLUS SBP < 90 or MAP <70,
urine output <0.5 mL/kg per hour,PaO2/FiO2 < 250, platelets < 80,000 or unexplained metabolic acidosis
• Septic shock: sepsis with hypotension for at least 1 hour despite fluid resuscitation
• Refractory septic shock: last > 1 hour and does not respond to fluids or pressors

Question 3

What is sepsis?

Answer 3

• “Sepsis is a life threatening organ dysfunction caused by a
dysregulated host response to an infection.”
• Persistent hypotension requiring vasopressors to keep MAP > 65 mmHg despite adequate fluid resuscitation
• AND serum lactate > 2 mmol/L
The European Society of Intensive Care Medicine/Society of Critical Care Medicine Third International Consensus
definitions for Sepsis and Septic Shock task force (the Sepsis-3 task force)

Question 4

Risk Factors for Sepsis

Answer 4

• Age • Malnutrition • Hypothermia • CVC use• Ventilation

* Aspiration• Chronic disease such as DM, renal failure • Immunodeficiency • Surgery

Question 5

Early Management bundle

Answer 5

Interventions Required: within 3 hours § Blood culture before
Antibiotics, § Antibiotics, § Lactate level

Question 6

Interventions Required: within 6 hrs

Answer 6

Lactate level repeated (If elevated)

Question 7

TO BE COMPLETED WITHIN 3 HOURS OF TIME OF

PRESENTATION:

Answer 7

1. Obtain blood cultures prior to administration of antibiotics.
2. Measure lactate level.
3. Administer broad spectrum antibiotics.
4. Administer 30ml/kg crystalloid for hypotension, defined as MAP < 65mmhg or lactate >4
   Severe Sepsis: Septic Shock Only
   Interventions Required: ALL of Severe Sepsis + § Fluid 30 ml/kg, (NO exclusionary criteria)

Question 8

Shock Assessment Physical Exam (ALL)

Answer 8

Vital Signs (T, HR, RR, BP) • Cardiopulmonary exam • Capillary refill evaluation • Peripheral Pulse evaluation • Skin evaluation

Question 9

Hemodynamics (2 of 4)

Answer 9

CVP • SVO2 • Bedside cardiovascular ultrasound, • Passive leg raise / fluid challenge Interventions Required: Persistent Hypotension § Within 1 hour of fluid add VASOPRESSOR Persistent Hypotension OR Lactate > 4 § Shock Assessment (1 of 2)

Question 10

TO BE COMPLETED WITHIN 6 HOURS OF TIME OF PRESENTATION:

SEPTIC SHOCK ONLY 2012 NQF: SEPSIS 0500

Answer 10

1. Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation to maintain a mean arterial pressure (MAP) ≥65mmHg)

Question 11

TO BE COMPLETED WITHIN 6 HOURS OF TIME OF

PRESENTATION:

Answer 11

. In the event of persistent arterial hypotension
despite volume resuscitation (septic shock) or initial
lactate ≥4 mmol/L (36mg/dl): § Measure central venous pressure (CVP)§ Measure central venous oxygen saturation
(ScvO2) 3. Re-measure lactate if elevated

Question 12

Sepsis Treatment

Answer 12

• SCCM recommends that, in the resuscitation of sepsis-induced
hypoperfusion, at least 30 ml/kg of IV crystalloid fluid be given within the first 3 hours.
• Antibiotics
• Choose Aminoglycosides or Aztreonam or Ciprofloxacin
• Cephalosporins, (1st and 2nd Generation) - or – Clindamycin - or -Daptomycin - or - Glycopeptides - or - Linezolid - or - Macrolides -or – Penicillins
• Vasopressors• Norepinephrine• Epinephrine or Vasopression