Sepsis/Septic Shock

Question 1

What is sepsis

Answer 1

Systemic response to infection leading to organ failure and death

Question 2

What is septic shock?

Answer 2

Subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound and increase motility.

Question 3

How is organ dysfunction determined?

Answer 3

SOFA score

Question 4

What are the components to a SOFA score? (7)

Answer 4

PaO2
Platelets
Bilirubin
MAP
GCS
Cr
Urine output

Question 5

A SOFA score of >/= ____ reflects an overall mortality risk of 10% in a hospitalized patient.

Answer 5

2

Question 6

Components of qSOFA?

Answer 6

RR >/= 22
GCS <13
SBP = 100

Question 7

Severe sepsis disrupts homeostasis by what 4 mechanisms?

Answer 7

Inflammation activation
Coagulation activation
Fibrinolysis suppression
Coagulopathy

Question 8

What are activated in sepsis that increase inflammation?

Answer 8

TNF, interleukins, and platelet activating factor

Question 9

Signs of inflammation?

Answer 9

Redness - Rubor
Heat -Calor
Swelling -tumor
Pain -dolor

Question 10

What interleukins down regulate the initial proinflammatory response?

Answer 10

IL4 and IL10

Question 11

What interleukins released cause tissue and capillary injury in cytokine storm?

Answer 11

IL1 and IL6

Question 12

What is the key inhibitor of fibrinolysis that has increased activity in sepsis?

Answer 12

Plasminogen activator inhibitor-1

PAI-1

Question 13

What metabolite is increased as a result of sepsis?

Answer 13

Lactic acid (lactate) is a byproduct of bacterial metabolism

Question 14

Lactate of > ___ is concerning for sepsis.

Answer 14

4

Question 15

A goal in treatment of sepsis is to decrease lactate to

Answer 15

5

Question 16

What is the earliest marker for bacterial infections?

Answer 16

Procalcitonin

Question 17

Normal value for procal?

Answer 17

<0.15

Question 18

Procal value concerning for sepsis?

Answer 18

> 2

Question 19

Where do the majority of sepsis patients come from?

Answer 19

ER (37%)

Floor (32%)

Question 20

What is the number 1 cause of sepsis?

Answer 20

community acquired pneumonia

Question 21

What are the symptoms of sepsis?

Answer 21

Shivering
Extreme pain
Pale or discolored skin
Sleepy, difficult to wake up or confused
I feel like I might die
Short of breath

Question 22

What are the SIRS criteria?

Answer 22

Temp >100.4
HR>90
Tachypnea >20 RR
>12000 WBC

Question 23

T/F? Blood cultures are positive in all septic patients.

Answer 23

False, only 1/3

Question 24

Treatment for sepsis?

Answer 24

Vanco +carbapenem or vanco + pip/tazo
IV fluids if MAP <65 or lactate>4
Tight glycemic control (insulin drip)
Vasopressors
Sedation

Question 25

What is the initial dose of fluids for a septic patient with MAP <65

Answer 25

30mL/kg

Question 26

Components of the hour 1 sepsis bundle

Answer 26

``` Lactate Blood cultures Antibiotics Fluid bolus Maintain MAP with vasopressors ```

Question 27

First line vasopressor?

Answer 27

Norepinephrine

Question 28

What medication can be added to a vasopressor to increase pressure?

Answer 28

Phenylephrine

Question 29

What vasopressors use is discouraged in sepsis?

Answer 29

Dopamine

Question 30

What is the only carbapenem without pseudomonas coverage?

Answer 30

Ertapenem

Question 31

CXR findings in ARDS?

Answer 31

Bilateral diffuse fluffy infiltrates

Question 32

What treatment should be initiated in a patient with early, severe ARDS?

Answer 32

Short course of neuromuscular blockers

Question 33

If your ARDS patient survives >24 hours, what must you prevent?

Answer 33

Nosocomial infections

Question 34

DVT prophylaxis in sepsis patients is done with?

Answer 34

Lovenox

Question 35

Stress induced ulcers prevented with what treatment?

Answer 35

PPIs or H2 blockers

Question 36

Name the 3 most common bacteria to cause sepsis.

Answer 36

Strep pneumo, e. coli, staph aureus