Sepsis Adults

Question 1

what is sepsis

Answer 1

life threatening organ dysfunction caused by a dysregulated host response to infection

Question 2

what is septic shock

Answer 2

subset of sepsis, underlying circulatory and cellular and metabolic abnormalities lead to substantially increased mortality risk

Question 3

characteristics of sepsis

Answer 3

TODE

threat to life
organ dysfunction
dysregulated host response
evidence of infection

Question 4

most common underlying cause of sepsis

Answer 4

infections

injuries, non-communicable diseases

Question 5

leading cause of global incidence of sepsis

Answer 5

diarrheal diseases

Question 6

leading cause of global incidence of sepsis related deaths

Answer 6

lrti

Question 7

pathogenesis of sepsis

Answer 7

pamps = initiators
cytokines = tissue damage and necrotic cell death = damps = endothelial dysfunction, coagulation activation, complement activation
lactate production

leads to organ dysfunction and decreased oxygen delivery

Question 8

risk factors for sepsis

Answer 8

predisposition to develop infection
progression from infection to organ dysfunction
extremes of age, male, african race

Question 9

host factors that affect host response

Answer 9

pro inflammatory reactions = collateral tissue damage

anti inflammatory responses = susceptibility to secondary infection

Question 10

characteristics of ards

Answer 10

hypoxemia and bilateral infiltrates of non-cardiac origin that arise within 7 days of infection

Question 11

classification of ards

Answer 11

mild 201-300
moderate 101-200
severe <100

Question 12

important differential for respiratory failure in sepsis

Answer 12

hydrostatic edema secondary to cardiac failure or volume overload

Question 13

presentation of cardiac injury in sepsis

Answer 13

hypotension
hypovolemia
diffuse capillary leakage
reduced systemic vascular resistance
depressed myocardial function

Question 14

sequence of events in cardiac injury in sepsis

Answer 14

early sepsis (shock): reduced volume status, low svr, low co
--> volume repletion occurs

result: low svr and high co

Question 15

aki is documented in ___ septic patients

Answer 15

more than 50%
increases risk of hospital death by 6-8 fold
occur in 25% in the absence of overt hypotension

Question 16

manifestations of aki

Answer 16

oliguria, azotemia, rising serum creatinine (needs dialysis)

Question 17

pathophysio of aki

Answer 17

• diffuse microcirculatory blood flow abnormalities
• inflammation
• cellular bioenergetic responses to injury

Question 18

typical cns dysfunction in sepsis

Answer 18

coma or delirium with no focal lesions

eeg: non-focal encephalopathy

Question 19

diffuse cerebral dysfunction caused by inflammatory response to infection without evidence of primary cns infection

Answer 19

sepsis associated delirium

Question 20

delirium screening tools

Answer 20

confusion assessment method for the icu

intensive care delirium screening checklist

Question 21

post sepsis neurological complications

Answer 21

critical illness polyneuropathy and myopathy

Question 22

adrenal dysfunction in sepsis is related to ___

Answer 22

reversible dysfunction of hypothalamic pituitary axis or tissue glucocorticoid resistance

Question 23

t/f there is a standard diagnostic test for sepsis

Answer 23

false, no test

Question 24

criteria for sepsis

Answer 24

• suspected (or documented) infection

- acute increase in >/= 2 sepsis related organ failure assessment (sofa) points

Question 25

criteria for septic shock

Answer 25

• suspected (or documented) infection
• vasopressor therapy to maintain map >/= 65 mmhg
• serum lactate >2.0 mmol/l

Question 26

sofa scoring

Answer 26

read

> /2 sofa points is septic, >/=10% risk for in hospital death

Question 27

components of qsofa

Answer 27

rr >/= 22
sbp less/= 100 mmhg
altered mental state

Question 28

management of sepsis

Answer 28

• immediate resuscitation (map >/= 65 mmhg with normal lactate <2.0)
• iv antibiotics within 1 hour
• stat blood culture before antibiotics
• respiratory support (peep)

Question 29

a guideline to decrease significantly sepsis patients’ mortality

Answer 29

surviving sepsis guideline

Question 30

points of emphasis in care of septic patients

Answer 30

• act quickly (within 1 hr)
• minimize time to treatment
• monitor closely

Question 31

1 hour bundle initial resucitation

Answer 31

1: measure lactate, remeasure after resuscitation or when initial lactate levels is elevated (> 2mmol/l)
2: stat blood cultures before antibiotics
3: broad spectrum iv within 1 hour
4: stat administration of 30 ml/kg crystalloid for hypotension or lactate levels >/= 4 mmol/l
5: if no response, give vasopressors to maintain map >/= 65 mmhg