Sepsis - clinical approach

Question 1

4 which cytokins stimulate PGE-2, resulting in the hypothalamous raising the set point for body temperature?

Answer 1

1. IL-1
2. IL-6
3. IFN
4. TNF-a

Question 2

How do microbial toxins cause fever?

Answer 2

stimulate PGE-2 –> raises hypothalamus set point

Question 3

pyrexia

Answer 3

100.4 F (38 C)

Question 4

hypothermia

Answer 4

< 95 F (35C)

Question 5

hyperpyrexia (hyperthermia)

Answer 5

106.7 F (41.5 C)

Question 6

euthermic

Answer 6

37 C (98.6 F)

Question 6

euthermic

Answer 6

37 C (98.6 F)

Question 7

Define systemic inflammatory response syndrome (SIRS)

Answer 7

systemic response to nonspecific infectious or non-infectoius inflammatory insult

Question 8

how are bacteremia and septicemia different?

Answer 8

bacteremia= bacteria in blood
septicemia = virus or fungi in blood

Question 9

SIRS criteria: need 2 or more of which conditions (6)?

Answer 9

1. fever or hypothermia
2. tachycardia > 90 beats/moin
3. tachypnea >20
4. hypocapnea < 32 mmHg
5. leukocytosis >12,000
6. leukopenia< 4,000

Question 10

define sepsis

Answer 10

SIRS + source

ex: SIRS + pneumonia = sepsis

Question 11

severe sepsis

Answer 11

SIRS + source + signs of end organ dysfunction

Question 12

7 signs of organ hypoperfusion or organ dysfunction

Answer 12

1. cardiac dysfunction w/hypotension
2. DIC
3. ARDS 2/hypoxia
4. abnormal EEG
5. lactate >2 mmol/L
6. capillary refill > 5 s
7. mottled skin

Question 13

septic shock is severe sepsis plus one of the following conditions:

(TQ!!)

Answer 13

1. systemic MAP < 60 mm Hg after fluid rescuscitation
2. need dopamine, NE or vasopressin to maintain MAP <60 mmHg

(<80 mm Hg in elderly or hypertensives)

MAP =1/3 (SBP-DBP) +DBP

Question 14

SIRS tx (6)

Answer 14

1. O2 & airway management
2. **broad spectrum IV abx w/in 1 hr of presentation **
3. cardiac telemetry
4. manual BP or arterial line
5. 2 large bore IV or central line
6. Fluid bolus

Question 15

Labs for SIRS (7)

Answer 15

1. CBC
2. CMP
3. lactic acid
4. UA
5. culter
6. pregnancy
7. sputum

Question 16

Early goal-directed therapy for SIRS

Answer 16

Goal 1: CVP between 8-12 mmHg
Goal 2: MAP > 65mmHg
Goal 3: central venous oxygen saturation >70% (but <80%)

Question 17

are steroids used in sepsis?

Answer 17

only if they recently had prolonged steroid use

Question 18

Why is glucose control important in SIRS?

(80-150mg/dL)

Answer 18

improves non morality-based outcomes

continuous insulin drip

Question 19

ARDS is the major cause of what?

Answer 19

non-cardiac pulmonary edema

looks like CHF

Question 20

ICU uses what instead of SIRS?

Answer 20

qSOFA

Question 21

What is qSOFA?

(quick SOFA)

Answer 21

1. mental status
2. respiratory rate >22
3. Systolic BP <100

score > 2 = increased mortality

Question 22

Which organs fail with sepsis (3)

Answer 22

1. heart (MI, ACS)
2. kidney (hpyoperfusion)
3. liver (bilirubin, AST, ALT)