Sepsis Questions

Question 1

3 signs of septic shock

Answer 1

need for meds to maintain SBP 65 or higher

serum lactate > 18

above sx despite adequate volume resuscitation

Question 2

lactic acid is a byproduct of __

that is produced during __

Answer 2

pyruvate

glycolysis

Question 3

lactate is a measure of

Answer 3

low O2 → anaerobic metabolism

Question 4

why is lactate elevated in sepsis

Answer 4

bp drop → decreased perfusion/O2 delivery → anaerobic environment → increased lactate

Question 5

sepsis is a vicious cycle of hypo__

and hypo__

Answer 5

hypotn

hypoperfusion

Question 6

in response to hypotn and hypoperfusion, the body releases __

in order to maintain tissue perfusion

Answer 6

epi

Question 7

exaggerated response to infxn

Answer 7

SIRS

Question 8

2 diagnostic criteria for sepsis

Answer 8

SIRS

PLUS

infxn

Question 9

what is used as early recognition to make dx and guide intervention in sepsis

Answer 9

SIRS criteria

Question 10

typical vital signs w. sepsis

Answer 10

sx/signs specific to infxn

arterial hypotn

temp: > 38.3C or < 36C

HR > 90

RR > 20 bpm

Question 11

signs of end-organ perfusion

Answer 11

warm, flushed skin

AMS, restlessness

oliguria/anuria

ileus/absent BS

Question 12

tx for PNA induced sepsis

Answer 12

pip-taz

PLUS

vanco

Question 13

tx for UTI induced sepsis

Answer 13

pip-taz

PLUS

vanco

Question 14

tx for cellulitis induced sepsis

Answer 14

vanco

PLUS

cefazolin

Question 15

why would you add tobramycin to sepsis tx

Answer 15

suspect p. aeruginosa

Question 16

mainstay abx tx for sepsis

Answer 16

pip-taz

PLUS

vanco

Question 17

abx timing if sepsis is definite

Answer 17

immediately - w.in 1 hr

Question 18

abx timing if sepsis probable + shock

Answer 18

immediately - w.in 1 hr

Question 19

abx timing if sepsis and NO shock

Answer 19

rapidly assess

administer w.in 3 hr

Question 20

biomarker for systemic bacterial infxn and sepsis

useful for determining bacterial etiology for sepsis

Answer 20

procalcitonin

Question 21

when should procalcitonin decrease

Answer 21

after abx administration

Question 22

does level of PCT correlate w. severity of infxn

Answer 22

yep!

Question 23

t/f: PCT can be used to help determine when to deescelate abx

Answer 23

T!

Question 24

when obtaining blood cultures, what 2 types of samples should you collect

Answer 24

aerobic

anaerobic

Question 25

how many sets of each type of sample should you collect

Answer 25

at least 2 sets from 2 different sites

Question 26

when should blood cultures be collected

Answer 26

before initiating abx

Question 27

bottom of vial on blood culture turns green, what does this mean

Answer 27

no growth

Question 28

bottom of via on blood sample turns orange, what does this mean

Answer 28

growth

Question 29

how is gram staining done

Answer 29

glass slide prepared w. culture from vial → microscopy

Question 30

what lines should not be used for culture samples

Answer 30

peripheral central (PICC)

Question 31

plasma volume expanding solute that contains electrolytes

Answer 31

crystalloids

Question 32

2 ex of crystalloids

Answer 32

LR D5W

Question 33

2 s.e of crystalloids

Answer 33

edema acidosis

Question 34

what is a balanced/buffered crystalloid

Answer 34

isotonic solute containing lytes buffered w. Cl

Question 35

3 benefits of balanced crystalloid

Answer 35

restores lyte balance maintains normal pH hydration

Question 36

solute containing large proteins like albumin remains intravascular to draw water from cells into intravascular space

Answer 36

colloids

Question 37

benefit of colloids

Answer 37

significantly increases volume *but can dehydrate cells*

Question 38

which lasts longer: crystalloids or colloids

Answer 38

crystalloids *albumin has shorter half life*

Question 39

fluid of choice in sepsis

Answer 39

crystalloids

Question 40

what is MAP

Answer 40

average bp during single cardiac cycle

Question 41

how is MAP measured

Answer 41

systolic and diastolic pressure readings

Question 42

MAP =

Answer 42

(CO x SVR) + (CVP)

Question 43

simple MAP calculation

Answer 43

MAP = (SBP + (2 x DBP)) / 3

Question 44

how is ABP measured

Answer 44

intra-arterial catheter

Question 45

how is CVP measured

Answer 45

vena cava catheter

Question 46

3 main bacteria associated w. newborn sepsis

Answer 46

**e.coli** **GBS** listeria

Question 47

2 bacteria responsible for early and late onset sepsis in neonates

Answer 47

e.coli GBS

Question 48

neonatal sepsis occurs in infants

Answer 48

90 days old

Question 49

bacteria associated w. sepsis in IVDU

Answer 49

**MRSA** also MSSA and GAS

Question 50

besides MRSA, what can be another source of sepsis in IVDU

Answer 50

HIV * sepsis alliance* * mc cause of death in HIV pt's*