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CDM I > Sepsis Part 1 > Flashcards

Sepsis Part 1 Flashcards

1
Q

Bacteremia: Define

A

Bacteria in the blood stream

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2
Q

Bacteremia: Bacteremia can be transient. What does this mean?

A
  • It is short-lived in the blood stream
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3
Q

Bacteremia: Bacteremia can be transient. What are causes of transient bacteremia?

A
  • Tooth brushing - UTI
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4
Q

Bacteremia: Bacteremia resulting from a UTI may cause an “overwhelming bacteremia.” This condition results in what common lab finding and what signs and symptoms?

A
  • (+) Blood cultures - Fever - Chills
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5
Q

Bacteremia: (T/F) Overwhelming bacteremia may lead to sepsis.

A
  • TRUE
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6
Q

Bacteremia: (T/F) Bacteremia is most often transient in nature.

A
  • TRUE
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7
Q

Sepsis: Define

A
  • Systemic response to infection
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8
Q

Sepsis: Severe complications?

A
  • Organ failure

- Death

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9
Q

Sepsis: How many people in the US annually develop sepsis?

A
  • 1.5 million people
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10
Q

Sepsis: How many people in the US annually die from sepsis (at least)?

A
  • 250,000 * Different sources vary based on coding
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11
Q

Sepsis: Mortality rate?

A

-40%

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12
Q

Sepsis: What is the old definition (~1992 until ~2016) of severe sepsis?

A

Severe sepsis Infection + SIRS + organ dysfunction

  • SIRS in the setting of infection, when associated with acute organ dysfunction, is called severe sepsis.
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13
Q

Sepsis: What is SIRS?

A
  • Systemic inflammatory response syndrome
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14
Q

Sepsis: What is the updated (2016) definition of sepsis?

A
  • Life-threatening Organ dysfunction caused by dysregulated host response to infection.
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15
Q

Sepsis: What is the big difference between the 2016 definition of sepsis and the “old” definition of sepsis?

A
  • 2016 definition removes the SIRS criteria
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16
Q

Sepsis: What is the updated (2016) definition of septic shock?

A
  • Subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound and increase mortality.
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17
Q

Organ dysfunction: What tool are we able to use to identify organ dysfunction early on in sepsis?

A
  • SOFA score
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18
Q

Organ dysfunction: Define organ dysfunction in terms of sepsis.

A
  • Identified as an acute change in SOFA score
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19
Q

Organ dysfunction: What does SOFA score stand for?

A
  • Sequential Organ failure Assessment score
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20
Q

SOFA score: What systems are considered when calculating this score?

A
  • Respiration - Coagulation - Liver - CV - CNS - Renal
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21
Q

SOFA score: What objective lab value is used to assess respiration in the SOFA score?

A
  • PAO2 - FIO2
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22
Q

SOFA score: What is the PaO2/FiO2 ratio? Why is it helpful?

A
  • Ratio of arterial oxygen partial pressure (PaO2 mmHg) to fractional inspired oxygen (FiO2) - Expressed as a fraction, not a percentage - AKA “the P/F ratio” - It is a widely used clinical indicator of hypoxemia, though its diagnostic utility is controve
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23
Q

SOFA score: What lab value is used to determine the coagulation score?

A
  • Platelets
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24
Q

SOFA score: What lab value is used to determine the liver score?

A
  • Bilirubin
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25
Q

SOFA score: What value is used to determine the CV score?

A
  • Mean arterial pressure
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26
Q

SOFA score: What value is used to determine CNS score?

A
  • Glascow Coma Scale (GCS)
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27
Q

SOFA score: What lab values are used to determine the renal score?

A
  • Creatinine

- Urine output

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28
Q

SOFA score: (T/F) SOFA score is most commonly utilized in the outpatient clinic environment.

A
  • False * It’s difficult to get an ABG in an outpatient setting, so it’s actually rarely utilized in an outpatient medical environment.
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29
Q

SOFA score: What is the assumed baseline score of any patient without sepsis?

A
  • zero
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30
Q

SOFA score: a score greater than or equal to ___ reflects an overall mortality risk of 10% in a hospitalized patient.

A
  • (greater than or equal to) 2
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31
Q

SOFA score: Because SOFA scores are difficult to perform in an outpatient setting, what score was created specifically to remedy this situation?

A
  • qSOFA score * quick SOFA score
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32
Q

qSOFA score: (T/F) The qSOFA score has all of the same systems involved as the SOFA score but the lab values associated with the respiratory system is different.

A
  • FALSE
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33
Q

qSOFA score: What are the components of the qSOFA score?

A
  • Respiratory rate - Altered mental status - Systolic blood pressure
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34
Q

qSOFA score: What are you assessing with the respiratory rate?

A
  • Greater than or equal to 22 is considered a positive
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35
Q

qSOFA score: How are you assessing altered mentation in a qSOFA score?

A
  • GCS < 13 is a positive
36
Q

qSOFA score: What is the cut-off value associated with the SBP being a positive indicator in the qSOFA score?

A
  • SBP less than or equal to 100 mmHg
37
Q

qSOFA score: How many of the three systems involved in the qSOFA score need to be positive for the provider to suspect a likely poor outcome with this patient?

A
  • Any 2 out of the 3
38
Q

Severe sepsis: This condition results from the body’s over-response to infection. The complications encountered with this condition can be described as a disruption of ___.

A

homeostasis

39
Q

Severe sepsis: How is homeostasis disrupted?

A
  • Inflammation activated
  • Coagulation activated
  • Fibrinolysis suppressed
  • Coagulopathy
40
Q

Severe sepsis: What component of a disrupted homeostasis is the driving force of acute organ dysfunction and death?

A
  • Coagulopathy
41
Q

Inflammation: (T/F) Inflammation is a normal response to infection.

A
  • TRUE
42
Q

Inflammation: How do Gram negative organisms activate inflammation?

A
  • Via their lipopolysacharide wall
43
Q

Inflammation: (T/F) Gram positive organisms cannot cause inflammation because they do not have the lipopolysacharide wall that Gram negative organisms do.

A
  • FALSE * It just occurs through a different mechanism of action
44
Q

Inflammation: How is inflammation activated by sepsis?

A
  • Proinflammatory mediators
  • TNF
  • Interleukins
  • Platelet activating factor
45
Q

Inflammation: The term “inflammation” is Latin: “to set on fire.” That said, what are the classic signs of inflammation?

A
  • Rubor - Calor - Tumor - Dolor
46
Q

Inflammation: A more commonly used term for rubor?

A
  • Redness
47
Q

Inflammation: A more commonly used term for calor?

A
  • Heat
48
Q

Inflammation: A more commonly used term for tumor?

A
  • Swelling
49
Q

Inflammation: A more commonly used term for dolor?

A
  • Pain
50
Q

Proinflammatory mediators: function?

A
  • Repair existing damage and limit new damage
51
Q

Proinflammatory mediators: What is the “check system” in place for the interleukin system?

A
  • to down-regulate initial Proinflammatory response.
52
Q

Proinflammatory mediators: Which interleukins are used to down-regulate the initial proinflammatory response?

A
  • IL4 - IL10
53
Q

Inflammation: (T/F) In sepsis, regulation of early response to infection is amplified.

A
  • FALSE - Regulation of early response to infection is LOST.
54
Q

Inflammation: What protein(s) and cytokine(s) are released in excess as a result of the massive systemic reaction that occurs in sepsis?

A
  • TNF - IL1 - IL6
55
Q

Inflammation: What is the direct result of excess TNF, IL1, and IL6 released into the bloodstream?

A
  • Excess tissue injury

- Diffuse capillary injury

56
Q

Inflammation: Excess TNF, IL1, and IL6 leads to excess tissue injury and diffuse capillary injury. This process is known as what?

A
  • Cytokine storm
57
Q

Inflammation: Complications from a cytokine storm?

A
  • tissue damage - Organ dysfunction
58
Q

Coagulation: (T/F) The inflammatory mediators released to fight infection also activate coagulation.

A
  • TRUE
59
Q

Coagulation: How does the infectious agent itself promote coagulation?

A
  • Via the endothelial damage It may cause
60
Q

Coagulation: The presence of d-dimer indicates what process?

A
  • the activation of clotting
61
Q

Coagulation: What event causes activation of coagulation factors?

A
  • blood contacting damaged tissue
62
Q

Fibrinolysis: Describe purpose.

A
  • the normal process to remove clots
63
Q

Fibrinolysis: (T/F) This process is suppressed in sepsis.

A
  • TRUE
64
Q

Fibrinolysis: What protein is the key inhibitor of fibrinolysis?

A
  • Plasminogen activator inhibitor-1 (PAI-1)
65
Q

Fibrinolysis: What cells produce PAI-1?

A
  • endothelial cells
66
Q

Fibrinolysis: Endotoxins are released by Gram negative rods. Does this decrease or increase the activity of PAI-1?

A
  • increase
67
Q

Microcirculation: What is the microcirculatory system responsible for?

A
  • the transport of oxygen to tissue throughout the body

* Microcirculatory function is essential for adequate tissue oxygen delivery and, thus, Organ function

68
Q

Microcirculation: How does injury to the microvascular impact the presence of neutrophils?

A
  • Increased neutrophil migration and adhesion
69
Q

Microcirculation: How does injury to the microvascular impact the process of coagulation at the site of injury?

A
  • Increased Coagulation
70
Q

Microcirculation: How does injury to the microvascular impact the process of fibrinolysis at the site of injury?

A
  • Decreased Fibrinolysis
71
Q

Microcirculation: How does injury to the microvascular impact the process of inflammation at the site of injury?

A
  • Increased Inflammation
72
Q

Microcirculation: Complications of injury to the microvascular system?

A
  • endothelial injury
  • Loss of barrier integrity
  • Altered Microcirculatory perfusion
73
Q

Results of sepsis: How is oxygen delivery impacted? Why?

A
  • Decreased oxygen delivery - capillary damage
74
Q

Results of sepsis: How is cardiac output impacted by sepsis?

A
  • Decreased cardiac output
75
Q

Results of sepsis: Describe the change in aerobic and/or anaerobic metabolism that takes place.

A
  • Increased anaerobic metabolism
76
Q

Results of sepsis: What metabolite is increased as a direct result of the increased anaerobic metabolism?

A
  • Lactic acid
77
Q

DIC: What does this stand for?

A
  • Disseminated Intravascular Coagulation
78
Q

DIC: Describe this process.

A
  • Widespread imbalance between Inflammation, Coagulation, and Fibrinolysis
79
Q

Lab findings in DIC: What parameters associated with coagulation are elevated in DIC?

A
  • PT - PTT - Fibrin monomers - D-dimers
80
Q

Lab findings in DIC: What parameters associated with coagulation are decreased in DIC?

A
  • Protein C - Fibrinogen - Platelet count
81
Q

Lab findings in severe sepsis: What markers and/or findings are elevated in severe sepsis?

A
  • Creatinine
  • ALT, AST, T bili
  • Lactate
  • Procalcitonin
82
Q

Lab findings in severe sepsis: Why would creatinine be elevated in severe sepsis?

A
  • Sign of Renal failure
83
Q

Lab findings in severe sepsis: Why would ALT, AST, and T bili be elevated in severe sepsis?

A
  • Sign of hepatic failure
84
Q

Lab findings in severe sepsis: An elevated lactate is a lactate over what value?

A

> 2 mmol/L

85
Q

Lab findings in severe sepsis: An elevated procalcitonin is a procalcitonin over what value?

A

> 2.0 ng/mL

86
Q

Lab findings in severe sepsis: What markers and/or findings are decreased in severe sepsis?

A
  • Urine output - mental status - blood pressure

CDM I (9 decks)

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