Sepsis and Septic Shock EXAM 2

Question 1

What is Sepsis?

Answer 1

a dysregulated response to an infection -> causing life-threatening organ dysfunction

Question 2

What is a Septic Shock?

Answer 2

sepsis related to hypotension despite treating with IV fluids

Question 3

What are the 4 components of the SIRS criteria?

Answer 3

1. Temperature >38°C or <36°C
2. HR >90 bpm
3. RR >20/min or PaO2 >32 mmHg
4. WBC >12,000 or <4000 or >10% immature bands

SBP <90 mmHg (not officially part of the criteria)

at risk for sepsis if 2 or more apply - but not reliable to tell if they have sepsis (need a source of infection)

Question 4

What does the SOFA score tell?
Which organs are assessed?

Answer 4

evaluates the risk of mortality related to sepsis

it looks at
-Respiration
-Coagulation
-Liver function
-Cardiovascular function
-CNS
-Renal function

the higher the score the higher the risk of mortality

Question 5

What are the criteria for the qSOFA?

Answer 5

RR >22/min
Altered mentation
SBP <100 mmHg

Question 6

What are the elements of the Hour-1 bundle?

Answer 6

1. lactate level >2 mmol/L (not enough oxygen, perfusion to tissue) - if elevated remeasure every 6 hours
2. obtain blood culture before giving antibiotics
3. administer broad-spectrum antibiotic
4. administer 30 ml/kg crystalloid (for hypotension or lactate > 4 mmol/L)
5. apply vasopressor if they are still hypotensive after giving fluids, maintain a MAP of > 65 mmHg

Question 7

What is the amount of fluid bolus given for resuscitation to patients with sepsis?

Answer 7

30 ml/kg of crystalloid
-LR preferred
-NS is possible but can cause hyperchloremic acidosis due to chloride content

-not for morbidly obese patients
-not for patients who are fluid-overloaded from heart failure

Question 9

Pseudomonas coverage

Answer 9

PC MAC
Pseudomonas
Cefepime
Meropenem
Aminoglycosides
Cipro/Levo

Question 10

MRSA coverage

Answer 10

CLTTR
Clindamycin, Linezolid, Tetracycline (Doxycycline), TMP-SMX, Rifampin

Question 11

Enterococcus coverage