Sepsis

Question 1

SIRS

Answer 1

Systemic Inflammatory Response System

triggered by infection, ischemia, infarction, injury.

DX by 2 or more of the following:

• HR >90bpm
• RR >22
• temp >38 or <36
• altered mental status
• WBC count >12.0 or <4.0

Question 2

sepsis

Answer 2

systemic inflammatory caused by an infection

Question 3

severe sepsis

Answer 3

sepsis that is further complicated by organ dysfunction, hypoperfusion, or hypotension.

Question 4

septic shock

Answer 4

this develops when hypotension caused in sepsis cannot be revered by fluid resuscitation and tissue perfusion abnormalities are present.

Question 5

MODS

Answer 5

Multi- Organ Dysfunction Syndrome.

the failure of two or more organs in a pt who is acutely ill.
homeostasis cannot be achieved without intervention.

mortality is 70% when three or more organs fail.

MODS is a progression from SIRS.

Question 6

sepsis presentation

Answer 6

initially a hyperdynamic state:
increased cardiac output and decreased systemic vascular resistance.
–> compensatory mechanisms like tachypnea and tachycardia
–> skin is initially warm and flushed

hyperdynamic state for more than 24 h:
body will become hypotensive
–> cool and clammy
–> MODS

Question 7

Septic Shock Presentation

Answer 7

CVS: biventricular dilation. low ejection fraction
increased or decreased temp
GI: GI bleed
paralytic ileus
NVS: agitation, altered LOC/mental status, coma (late)
Resp: acute resp distress syndrome (ARDS)
crackles, hyperventilation, hypoxemia,
pulmonary htn, resp alkalosis–>acidosis, resp
failure
Renal: decreased urine output
Skin: warm and flushed–> cool and clammy, mottled
diagnostic findings:
increased glucose
increased lactate
decreased platelets
positive blood cultures
decreased urine Na
higher or lower WBC

Question 8

sepsis presentation

Answer 8

A confirmed or suspected source of infection, PLUS:

altered mental status
fever (>38.3)
HR >90
hyperglycemia
hypothermia
edema
tachypnea

increased CRP, procalcitonin
leukocytosis or leukopenia, or normal WBC

hypotension (<90) or decrease systolic value of >40

organ hypoperfusion symptoms:
decreased urine output 
hypoxemia 
high PTT and INR 
hyperbilirubinemia
ileus
increased creatinine 
thrombocytopenia (low platelets)

hyperlactatemia
low cap refill

Question 9

4 MAIN INTERVENTIONS FOR SEPSIS

Answer 9

1. early identification and notify the MRP or physician
2. LABS and DIAGNOSTICS
   - lactate (notify if >2)
   CBC, INR, PTT, electrolytes, BUN, creatinine, glucose, Liver Function Tests, lipase, troponin
   - blood cultures
   - urinalysis
   - sputum
   CXR and 12 lead ECG
3. IV fluid resuscitation and broad spectrum ABX
4. Monitoring
   VS, GCS, Urine output