Sepsis/Septic Shock Flashcards
What is sepsis
Systemic response to infection leading to organ failure and death
What is septic shock?
Subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound and increase motility.
How is organ dysfunction determined?
SOFA score
What are the components to a SOFA score? (7)
PaO2 Platelets Bilirubin MAP GCS Cr Urine output
A SOFA score of >/= ____ reflects an overall mortality risk of 10% in a hospitalized patient.
2
Components of qSOFA?
RR >/= 22
GCS <13
SBP = 100
Severe sepsis disrupts homeostasis by what 4 mechanisms?
Inflammation activation
Coagulation activation
Fibrinolysis suppression
Coagulopathy
What are activated in sepsis that increase inflammation?
TNF, interleukins, and platelet activating factor
Signs of inflammation?
Redness - Rubor
Heat -Calor
Swelling -tumor
Pain -dolor
What interleukins down regulate the initial proinflammatory response?
IL4 and IL10
What interleukins released cause tissue and capillary injury in cytokine storm?
IL1 and IL6
What is the key inhibitor of fibrinolysis that has increased activity in sepsis?
Plasminogen activator inhibitor-1
PAI-1
What metabolite is increased as a result of sepsis?
Lactic acid (lactate) is a byproduct of bacterial metabolism
Lactate of > ___ is concerning for sepsis.
4
A goal in treatment of sepsis is to decrease lactate to
5
What is the earliest marker for bacterial infections?
Procalcitonin
Normal value for procal?
<0.15
Procal value concerning for sepsis?
> 2
Where do the majority of sepsis patients come from?
ER (37%)
Floor (32%)
What is the number 1 cause of sepsis?
community acquired pneumonia
What are the symptoms of sepsis?
Shivering Extreme pain Pale or discolored skin Sleepy, difficult to wake up or confused I feel like I might die Short of breath
What are the SIRS criteria?
Temp >100.4
HR>90
Tachypnea >20 RR
>12000 WBC
T/F? Blood cultures are positive in all septic patients.
False, only 1/3
Treatment for sepsis?
Vanco +carbapenem or vanco + pip/tazo IV fluids if MAP <65 or lactate>4 Tight glycemic control (insulin drip) Vasopressors Sedation
What is the initial dose of fluids for a septic patient with MAP <65
30mL/kg
Components of the hour 1 sepsis bundle
Lactate Blood cultures Antibiotics Fluid bolus Maintain MAP with vasopressors
First line vasopressor?
Norepinephrine
What medication can be added to a vasopressor to increase pressure?
Phenylephrine
What vasopressors use is discouraged in sepsis?
Dopamine
What is the only carbapenem without pseudomonas coverage?
Ertapenem
CXR findings in ARDS?
Bilateral diffuse fluffy infiltrates
What treatment should be initiated in a patient with early, severe ARDS?
Short course of neuromuscular blockers
If your ARDS patient survives >24 hours, what must you prevent?
Nosocomial infections
DVT prophylaxis in sepsis patients is done with?
Lovenox
Stress induced ulcers prevented with what treatment?
PPIs or H2 blockers
Name the 3 most common bacteria to cause sepsis.
Strep pneumo, e. coli, staph aureus
