Sepsis Questions Flashcards
3 signs of septic shock
need for meds to maintain SBP 65 or higher
serum lactate > 18
above sx despite adequate volume resuscitation
lactic acid is a byproduct of __
that is produced during __
pyruvate
glycolysis
lactate is a measure of
low O2 → anaerobic metabolism
why is lactate elevated in sepsis
bp drop → decreased perfusion/O2 delivery → anaerobic environment → increased lactate
sepsis is a vicious cycle of hypo__
and hypo__
hypotn
hypoperfusion
in response to hypotn and hypoperfusion, the body releases __
in order to maintain tissue perfusion
epi
exaggerated response to infxn
SIRS
2 diagnostic criteria for sepsis
SIRS
PLUS
infxn
what is used as early recognition to make dx and guide intervention in sepsis
SIRS criteria
typical vital signs w. sepsis
sx/signs specific to infxn
arterial hypotn
temp: > 38.3C or < 36C
HR > 90
RR > 20 bpm
signs of end-organ perfusion
warm, flushed skin
AMS, restlessness
oliguria/anuria
ileus/absent BS
tx for PNA induced sepsis
pip-taz
PLUS
vanco
tx for UTI induced sepsis
pip-taz
PLUS
vanco
tx for cellulitis induced sepsis
vanco
PLUS
cefazolin
why would you add tobramycin to sepsis tx
suspect p. aeruginosa
mainstay abx tx for sepsis
pip-taz
PLUS
vanco
abx timing if sepsis is definite
immediately - w.in 1 hr
abx timing if sepsis probable + shock
immediately - w.in 1 hr
abx timing if sepsis and NO shock
rapidly assess
administer w.in 3 hr
biomarker for systemic bacterial infxn and sepsis
useful for determining bacterial etiology for sepsis
procalcitonin
when should procalcitonin decrease
after abx administration
does level of PCT correlate w. severity of infxn
yep!
t/f: PCT can be used to help determine when to deescelate abx
T!
when obtaining blood cultures, what 2 types of samples should you collect
aerobic
anaerobic
how many sets of each type of sample should you collect
at least 2 sets from 2 different sites
when should blood cultures be collected
before initiating abx
bottom of vial on blood culture turns green, what does this mean
no growth
bottom of via on blood sample turns orange, what does this mean
growth
how is gram staining done
glass slide prepared w. culture from vial → microscopy
what lines should not be used for culture samples
peripheral
central (PICC)
plasma volume expanding solute that contains electrolytes
crystalloids
2 ex of crystalloids
LR
D5W
2 s.e of crystalloids
edema
acidosis
what is a balanced/buffered crystalloid
isotonic solute containing lytes buffered w. Cl
3 benefits of balanced crystalloid
restores lyte balance
maintains normal pH
hydration
solute containing large proteins like albumin
remains intravascular to draw water from cells into intravascular space
colloids
benefit of colloids
significantly increases volume
but can dehydrate cells
which lasts longer: crystalloids or colloids
crystalloids
albumin has shorter half life
fluid of choice in sepsis
crystalloids
what is MAP
average bp during single cardiac cycle
how is MAP measured
systolic and diastolic pressure readings
MAP =
(CO x SVR) + (CVP)
simple MAP calculation
MAP = (SBP + (2 x DBP)) / 3
how is ABP measured
intra-arterial catheter
how is CVP measured
vena cava catheter
3 main bacteria associated w. newborn sepsis
e.coli
GBS
listeria
2 bacteria responsible for early and late onset sepsis in neonates
e.coli
GBS
neonatal sepsis occurs in infants
90 days old
bacteria associated w. sepsis in IVDU
MRSA
also MSSA and GAS
besides MRSA, what can be another source of sepsis in IVDU
HIV
- sepsis alliance*
- mc cause of death in HIV pt’s*
