Sepsis (Final) Flashcards
What is sepsis?
The consequence of a dysregulated inflammatory response to an infection. Gram-positive bacteria are the pathogens most commonly isolated from Pts with sepsis.
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection; organ dysfunction is defined as an increase of two or more points in the sequential (sepsis-related) organ failure assessment (SOFA) score.
What are the components of the SIRS criteria?
- Temp
- >100.4 F
- < 96.8F
- RR
- >20
- HR
- >90
- WBC
- >12,000
- <4,000
- >10% bands
- PCO2
- <32 mmHg
She said to know this!
Define sepsis using the SIRS criteria
- 2 SIRS criteria met
- +
- Confirmed or suspected infection
Define severe sepsis using the SIRS criteria
- Sepsis
- +
- Signs of end-organ damage
- +
- Hypotension (SBP < 90)
- +
- Lactate > 4 mmol
Define septic shock using the SIRS criteria
- Severe sepsis with persistent
- Signs of end-organ damage
- +
- Hypotension (SBP < 90)
- +
- Lactate > 4 mmol
- Signs of end-organ damage
What is the SOFA score used for?
- SOFA score is an illness-severity score used to predict mortality of critically ill patients
- Patients with suspected sepsis can be rapidly identified if they meet at least 2 of the three criteria of the qSOFA
Is lactate or qSOFA better for sepsis prognostication?
Lactate
Components of the qSOFA score
- Low blood pressure
- SBP ≤ 100 mmHg
- High respiratory rate
- RR ≥ 22 breaths/min
- Altered mentation
- GCS ≤ 14
Each is worth one point, a score of 2 or more indicates Pts who may have sepsis
Is qSOFA a screening tool or a diagnostic tool?
Screening tool
When is SOFA used (not qSOFA)
Great in the ICU setting but cumbersome in the ED
What is a problem with the SIRS criteria?
SIRS may over AND under diagnose
Risk factors for developing sepsis
- Advanced age
- Immunosuppression/steroid use/malnutrition
- DM/CA/HIV/Liver disease
- Recent abx use/drug-resistance
- Recent procedures or travel
- Alcohol/drug use
DDx for a fever
- Sepsis
- Drug reaction
- VTE
- Malignancy
- Rheumatological
Malignancy and rheumatological causes are often missed
WBC findings in sepsis
Greater than 12,000 or 140 mg/dL in the absence of diabetes
CRP findings in the setting of sepsis
CRP > 2.5 S.D. above normal
ABG findings in the setting of sepsis
Arterial hypoxemia
INR/aPTT findings in the setting of sepsis
- INR > 1.5
- or
- aPTT > 60s
Platelet findings in the setting of sepsis
Platelet count 4 mg/dL
Lactate findings in the setting of sepsis
Lactate > 2 mmol/L
Procalcitonin findings in the setting of sepsis
Procalcitonin > 2 S.D. above normal
Adrenal findings in the setting of sepsis
Adrenal insufficiency or euthyroid sick syndrome L
Pt is a 48 year old female with PMH of HIV who presented to the hospital with diarrhea for the last 5 days. She’s unable to tolerate anything PO. Vitals: temp 39.0, RR 15, HR 104, BP 90/70. On exam she had dry MM, tachy with a regular rhythm, tender abd, but no distention. Her labs are significant for an abnormal CBC with WBC at 19k. Abnormal BMP with cr of 2.1, Na 131, and K 3.0. ECG nml. UA nml.
What should you do next?
a. ) This patient meets sepsis criteria. Start IVF, identify source and get blood cultures
b) This patient does not meet sepsis criteria. Start IVF and Imodium
c. ) This patient meets sepsis criteria and is hemodynamically unstable Start IVF, broad-spectrum abx (Vanco, cefepime, and metronidazole), identify the source, and get blood cultures
d. ) The patient had diarrhea she can d/c home
c.) This patient meets sepsis criteria and is hemodynamically unstable Start IVF, broad-spectrum abx (Vanco, cefepime, and metronidazole), identify the source, and get blood cultures
Pt is a 48 year old female with PMH of HIV who presented to the hospital with diarrhea for the last 5 days. She’s unable to tolerate anything PO. Vitals: temp 39.0, RR 15, HR 104, BP 90/70. On exam she had dry MM, tachy with a regular rhythm, tender abd, but no distention. Her labs are significant for an abnormal CBC with WBC at 19k. Abnormal BMP with cr of 2.1, Na 131, and K 3.0. ECG nml. UA nml.
You decide to do a full sepsis work-up. What else should you consider in this Pt?
HIV status (What’s her most recent CD4 and viral load)?
Pt is a 48 year old female with PMH of HIV who presented to the hospital with diarrhea for the last 5 days. She’s unable to tolerate anything PO. Vitals: temp 39.0, RR 15, HR 104, BP 90/70. On exam she had dry MM, tachy with a regular rhythm, tender abd, but no distention. Her labs are significant for an abnormal CBC with WBC at 19k. Abnormal BMP with cr of 2.1, Na 131, and K 3.0. ECG nml. UA nml.
You decide to do a full work-up what all should be included in this?
- Blood cultures
- Chest X-ray
- UA (already have)
- Stool PCR (Since she is having diarrhea)
- CD4/Viral load
- CT-abdomen