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Clinical Medicine II > Sepsis > Flashcards

Sepsis Flashcards

1
Q

What does SIRS stand for?

A

Systemic
Inflammatory
Response
Syndrome

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2
Q

What is the criteria for SIRS?

A

At least 2 or more of the following:

  • Fever >38˚ C
  • Hypothermia < 36˚ C
  • Tachycardia > 90
  • Tachypnea > 20

or

  • Hypocapnia < 32 Co2

or

  • Need for mechanical ventilator assistance
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3
Q

Definition of Sepsis?

A
  • Life threatening organ dysfunction

- Caused by a dysregulated host response to infection

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4
Q

What triggers sepsis?

A
  • Pre-existing infection
  • Triggers an inflammatory response
  • Results in a chain reaction throughout the body’s organ systems
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5
Q

Organs affected in sepsis during a inflammatory response?

A
  • Lungs
  • Kidney
  • Skin
  • GI tract
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6
Q

Sepsis is defined by?

A
  • At least 2 of the items under SIRS criteria

PLUS

  • Leukocytosis
    > 12K
  • Leukopenia
    < 4K

or

  • Left shift (>0%) immature band cells

AND

  • Suspected or Proven infection
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7
Q

Definition of Septic Shock?

A
  • Subset of sepsis with profound Circulatory + Cellular/Metabolic dysfunction

Ex.
Severe sepsis + Hypotension despite adequate fluid resuscitation

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8
Q

What type of infection can lead to Sepsis?

A

Any type of infection;

  • Bacterial
  • Viral
  • Fungal
  • Parasitic
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9
Q

What are some risk factors for Sepsis and Sepsis Shock?

A
  • Extreme ages
  • Genetics
  • Recent surgery
  • Hospitalization
  • Malnutrition
  • Chronic Illness
  • Immunosuppression
  • Indwelling catheters
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10
Q

What are the age ranges for risk factors for sepsis and septic shock?

A
  • Infants (Premature, Low birth weight, Maternal Group B Strep infection)
  • Elderly > 65 y/o
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11
Q

What are some genetic risk factors for sepsis and septic shock?

A
  • Interleukin IB-511
    Increased risk of mortality from sepsis
  • Deficiency of Mannose Binding Lectin
    Increased risk of Sepsis
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12
Q

What are examples of Indwelling catheters and can they cause sepsis?

A
  • Foley Catheters
  • Central lines
  • Yes at higher risk of sepsis
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13
Q

What are some causes of sepsis?

A
  • Respiratory 35%
    Most Common
  • Genitourinary 25%
  • GI 11%
  • Skin and Soft Tissue 11%

-

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14
Q

What are the most common primary sites (80%) of infection causing sepsis?

A
  • Respiratory
  • Genitourinary
  • GI
  • Skin and Soft Tissue
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15
Q

What is the most common respiratory cause leading to sepsis?

A
  • Pneumonia

- Strep and Staph

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16
Q

Most common site leading to sepsis in pt’s > 65

A
  • GU tract (Genitourinary)
  • DM pt’s or on broad spectrum abx
  • Candida infection
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17
Q

Most common cause of GI sepsis?

A
  • Poly microbial
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18
Q

Skin and Soft tissue causes of Sepsis?

A
  • Cellulitis (Staph most common or Strep)
  • Wounds
  • Necrotizing Fasciitis
  • MRSA prevalent
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19
Q

Less common sites of Sepsis?

A
  • Bone and Joint (Osteomylitis, Septic Arthritis)

- CNS (Meningitis, Encephalitis, Epidural abscess)

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20
Q

What are the important PE exam finding sites for sepsis?

A
  • Vitals
  • Skin
  • EENT
  • CV
  • GI
  • Respiratory
  • GU
  • Neuro
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21
Q

Important SKIN PE findings for sepsis?

A
  • Cellulitis
  • IV Sites
  • Catheters
  • Abscesses
  • Petechiae
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22
Q

Important EENT PE findings for sepsis?

A
  • Mastoid tenderness
  • Sinus pain pressure
  • Sore throat
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23
Q

Important CV PE findings for sepsis?

A
  • New Murmur
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24
Q

Important respiratory findings for sepsis?

A
  • Cough
  • Hemoptysis
  • Rales
  • Rhonchi
  • Diminished breath sound
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25
Q

GI important PE findings for sepsis?

A
  • Pain
  • Guarding
  • Rebound
  • Diarrhea
26
Q

GU important PE findings for sepsis?

A
  • Indwelling catheter
  • Suprapubic tenderness
  • CVA Tenderness
27
Q

Most common clinical manifestations for sepsis?

A
  • Fever

- Most common presentation

28
Q

What pt’s can be afebrile and still be septic?

A
  • Elderly patients
  • Debilitated
  • Chronic alcohol use
  • Due to their fever threshold being atypical
29
Q

Other common clinical findings in septic pt’s?

A
  • Hypotension (Very common)
  • Tachcardia
  • Tachypnea
  • Withdrawal & Agitation (Elderly important sign - increased Lactase)
30
Q

Dx of sepsis based on signs and symptoms is very concrete

T of F

A
  • False
  • S&S very variable
  • Providers need to have a low threshold of suspicion
31
Q

What are some key pt history components?

A
  • Underlying disease
  • Co-morbidities
  • Recent antibiotic use
  • Travel
  • Sick contacts
32
Q

Dx of sepsis is primarily based on ?

A
  • History & PE
33
Q

What do lab results and cultures provide in dx sepsis?

A
  • Lab results = Evidence of Inflammation & Infection

- Culture = Confirms DX

34
Q

Initial lab test for sepsis pt’s must include?

A
  • Lactate (Very important, key finding)
  • CBC
  • Metabolic panel
  • Coagualtion test
  • Blood gas
  • UA
  • Blood cultures
  • Cultures from possible sources
  • Mean arterial pressure
35
Q

What does the SOFA criteria evaluate in sepsis pt’s?

A
  • Uses 6 key physiological parameters to predict mortality
  • Sequential
  • Organ
  • Failure
  • Assessment

0-4

0 = Normal 
4 = Really Really Abnormal

Max score 24

36
Q

What are the 6 key physiological parameters of the SOFA criteria?

A
  • Respiratory
    (O2 transfer in lungs)
  • Coagulation (Platelets)
  • Liver
    (Bilirubin count)
  • Heart
    (MAP & Vasopressors Dopamine, Epi, NorEpi)
  • CNS
    (GCS Score)
  • Kidney
    (Creatinine and Urine output)
37
Q

What are the SOFA respiratory ranges?

A
  • Normal 300 - 500

< 300 Abnormal gas exchange

< 200 Severe hypoxia (Respiratory support)

38
Q

Glasgow Coma Scale

A
  • Motor (6-1)
  • Verbal (5-1)
  • Eye (4-1)
  • 3 Min
  • 15 Max
39
Q

Management of sepsis consist of?

A
  • ICU admission
  • Respiratory stabilization (Intubation)
  • Hemodynamic stabilization (Vasopressors)
  • Source control
40
Q

What must be initiated within 1 hour with a septic pt?

A
  • Fluids with crystalloids
  • Consider Vasopressors NorEpi (First Choice)
  • Antibiotics AFTER collecting cultures (Decreases mortality by 33%)
41
Q

What must be done within 12 hours with a septic pt?

A
  • Source control
  • D&I
  • Drain abscess
  • Debride tissue
  • Remove infected device
42
Q

How do you initiate antibiotic therapy in a septic pt?

A
  • Initiate after culture

- Administer broad spectrum antibiotics

43
Q

What are the CAP broad spectrum antibiotics used for septic pts?

A

Broad-spectrum β-lactam agent

  • Cefotaxime
  • Ceftazidime
  • Cefepime
  • Piperacillin-tazobactam

plus

either a respiratory Fluoroquinolone

  • Moxifloxacin or Levofloxacin

or

  • Azithromycin
44
Q

What are the HCAP broad spectrum antibiotics used for septic pts?

A
  • Antipseudomonal carbapenem
  • Imipenem, Doripenem

or

  • Meropenem

or

  • Cefepime
45
Q

What are the Community UTI broad spectrum antibiotics used for septic pts?

A
  • Antipseudomonal fluoroquinolone

- Ciprofloxacin or Levofloxacin

46
Q

What are the medically care associated UTI broad spectrum antibiotics used for septic pts?

A
  • Vancomycin

plus

  • Imipenem

or

  • Meropenem or Cefepime
47
Q

What are the Soft tissue broad spectrum antibiotics used for septic pts?

A
  • Vancomycin

or

  • Daptomycin

plus

  • Imipenem

or

  • Meropenem
48
Q

What are the two drugs added to broad spectrum antibiotic tx for septic pts if there is flu like symptoms or C. Diff?

A
  • Oseltamivir (Flu tx)

- Vancomycin (C. Diff tx)

49
Q

Hemodynamic support for septic pts consist of?

A
  • Fluids with crystalloids
  • Vasopressors to maintain a MAP
    > 65mmHg
    Norepi first choice
50
Q

Glycemic control of septic pts consists of ?

A
  • Glycemic control

BGL < 180 mg/dl

51
Q

What must be done within 48 hours after admission into hospital?

A
  • DVT prophylaxis
  • Stress ulcer prophylaxis
  • Nutrition (oral or enteral)
52
Q

Why must you have a low threshold, high suspicion of sepsis in pt’s?

A
  • Presentation is variable

- Elderly subtle signs and symptoms

53
Q

What are some atypical signs and symptoms of elderly pt’s with sepsis?

A
  • Delirium
  • Urinary incontinence
  • Weakness
  • Anorexia
  • Falls
  • Afebrile
  • Tachycardia
  • Hypoxemia
54
Q

T or F

Minor delays in sepsis tx with elderly pt’s increases the chances of death?

A
  • True

- Higher mortality

55
Q

Overall prognosis of Severe sepsis mortality and Septic shock mortality?

A
  • Severe sepsis mortality 30%

- Septic shock mortality 70%

56
Q

Septic shock pts mortality rate increases by ______ every ______ that _______ are delayed?

A
  • 7%
  • HOUR
  • Antibiotics
57
Q

True or False

Identifying septic pt’s early is crucial to treatment?

A
  • True
58
Q

Fluid resuscitation & Antibiotics should be delivered within ?

A
  • 1 Hour
59
Q

What is the earliest lab key finding in helping to dx sepsis in a pt?

A
  • Lactate measurements
60
Q

What are important steps in management of a septic pt?

A
  • Aggressive IV resuscitation
  • Laboratory and Imaging studies (Infection Identification)
  • Initiating empiric broad-spectrum antimicrobial therapy
  • Evaluation by ICU medical team

Clinical Medicine II (9 decks)

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