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RRPA Clinical Decision Making I > Sepsis/Septic Shock > Flashcards

Sepsis/Septic Shock Flashcards

1
Q

What is bacteremia?

A

Bacteria in the bloodstream

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2
Q

What is sepsis?

A

A systemic response to an infection leading to organ failure and death.

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3
Q

What is septic shock?

A

Subset of sepsis with circulatory and cellular/metabolic abnormalities

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4
Q

How can you monitor for organ dysfunction?

A

SOFA (sequential organ failure assessment) score

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5
Q

What is needed to calculate a SOFA score?

A 
PaO2
Platelets
Bilirubin
MAP
GCS score
Cr and Urine output
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6
Q

A SOFA score greater than ___ reflects a mortality risk of 10% in a hospitalized patient.

A

2

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7
Q

SOFA scores cannot be done quickly at bedside. What assessment can be used quickly at bedside to assess for sepsis?

A

qSOFA

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8
Q

What are the components of the qSOFA?

A

Respiratory rate >/= 22
Altered mental status (GCS <13)
Systolic BP = 100mmhg

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9
Q

How many components of the qSOFA must be met to indicate a poor outcome?

A

2

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10
Q

What is the driving force of acute organ dysfunction in sepsis?

A

Coagulopathy

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11
Q

List 4 classic signs of inflammation.

A

Redness
Heat
Swelling
Pain

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12
Q

What is responsible for down regulation of the initial proinflammatory response?

A

Interleukin system (IL4 and IL10)

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13
Q

Severe sepsis disrupts homeostasis by activating ____ and _____, and suppressing ______.

A

Inflammation and coagulation

Finbrinolysis

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14
Q

What is the key inhibitor of fibrinolysis in sepsis?

A

Plasminogen activator inhibitor 1 (PAI-1)

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15
Q

PAI-1 is produced by?

A

Endothelial cells

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16
Q

______ released by gram negative rods increase activity of PAI-1

A

Endotoxins

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17
Q

What are the lab findings of DIC?

A

Elevated: PT, PTT, Fibrin monomers, D-dimer
Decreased: Protein C, Fibrinogen, Platelet count

18
Q

What are the lab findings of sepsis?

A

Elevated: Cr, ALT AST T bili, Lactate, Procalcitonin.

19
Q

What is procalcitonin?

A

Protein biomarker for bacterial infection

20
Q

What is the normal level for procalcitonin?

What value suggests sepsis?

A

Normal is = 0.15 Values > 2.0 is suggestive of sepsis

21
Q

Where do the majority of sepsis patients originate?

A

Emergency department (37%) and Floor (32%)

22
Q

What are the effects of sepsis on the body?

A
  1. Decreased 02 delivery because of damaged to capillaries
  2. Decreased cardiac output (increase heart rate)
  3. increased anaerobic metabolism
  4. DIC
23
Q

What is the most common cause of severe sepsis?

A

community acquired pneumonia

24
Q

A lactate level greater than what indicates severe sepsis?

A

greater than 2mmol/L

25
Q

What are the three phases of sepsis treatment?

A
  • Resuscitation Phase ( 1st 6hours/sooner the better
  • initial management phase (24 hours)
  • Maintenance phase (>24 hours)
26
Q

Do you assess and maintain airway during the resuscitation phase?

A

Yes

27
Q

What elements are included in the resuscitation phase?

A
  1. Access and maintain airway
  2. Pan-culture
  3. Initiate appropriate antibiotic therapy
    What is this?
  4. IV fluids (If MAP <65 or lactate >4) initial volume 30ml/kg
  5. Tight glycemic control (continuous insulin drip)
  6. Vasopressors-dobutamine, norepinephrine, dopamine, phenylephrine, epinephrine, vasopressin
  7. Sedation
  8. Steroids possibly
28
Q

What are the goals of sepsis resuscitation? (other than survival of course)

A
  1. CVP 8-12mm hg
  2. MAP 65mm Hg
  3. Urine output 0.5ml/kg/hr
  4. General venous or mixed venous O2 sat 70% or 65% (respectively)

Reduces 28-day mortality rate

29
Q

What do you do during the hour 1 bundle: initial resuscitation

A
  1. Measure lactate level
  2. Obtain blood cultures before admin of antibiotics
  3. Administer broad spectrum antibiotics (vanco, pip/tazo/ carbapenems)
  4. begin rapid admin of 30ml/kg crystalloid for hypotension or lactate > 4
  5. Maintain MAP >/= 65mmhg (vasopressors)
30
Q

Why would you administer vasopressor?

A

Vasopressors are used to stimulate vasoconstriction and increase blood pressure for pts in shock

31
Q

What are some vasopressor medications?

A
  1. Norepinephrine- this is the preferred first line
  2. Vasopressin
  3. Epinephrine
  4. Phenylephrine- commonly used as add on
32
Q

What vasopressor analog is discouraged from being used?

A

dopamine

33
Q

What elements are apart of the “initial management phase”

A
  1. Continue the resuscitation phase
  2. Monitor cultures for targeting antibiotic therapy
  3. Constant monitoring of vasopressors (maintenance of MAP >65mmhg
34
Q

What is a common respiratory problem and needs special attention to pressure and volumes?

A

ARDS

35
Q

What will ARDS look like on X-ray?

A

Bilateral diffuse fluffy infiltrate, normal cardiac size

36
Q

What type of medications should you avoid when giving central nervous system support?

A

Avoid neuromuscular blockers if possible (in pts without ARDS)

37
Q

What type of protocol do you implement with central nervous system support?

A

Sedation protocol

38
Q

What is involved with the maintenance phase?

A
  1. if survive >24 hours, attention to preventing nosocomial infections
  2. Restore premorbid condition
  3. Tailor antibiotic therapy as culture info available
39
Q

What is involved with general supportive care for sepsis pts?

A
  1. Blood glucose management <180 mg/dl
  2. Dialysis for renal failure or fluid overload
  3. DVT prophylaxis- Low molecular weight heparin
  4. Stress-ulcer prophylaxis- commonly a PPI or H2 blocker
  5. Enteral feeding if possible
40
Q

What causes sepsis?

A
  1. Lungs
  2. Urinary tract
  3. GI
  4. Skin and Soft tissue
41
Q

What are most common bacteria for sepsis?

A

strep pneumo, staph and ecoli

RRPA Clinical Decision Making I (17 decks)

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