Sepsis/Septic Shock Flashcards

1
Q

What is sepsis

A

Systemic response to infection leading to organ failure and death

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2
Q

What is septic shock?

A

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

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3
Q

How is organ dysfunction determined?

A

SOFA score

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4
Q

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

A
PaO2
Platelets
Bilirubin
MAP
GCS
Cr
Urine output
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5
Q

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

A

2

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6
Q

Components of qSOFA?

A

RR >/= 22
GCS <13
SBP = 100

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7
Q

Severe sepsis disrupts homeostasis by what 4 mechanisms?

A

Inflammation activation
Coagulation activation
Fibrinolysis suppression
Coagulopathy

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8
Q

What are activated in sepsis that increase inflammation?

A

TNF, interleukins, and platelet activating factor

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9
Q

Signs of inflammation?

A

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

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10
Q

What interleukins down regulate the initial proinflammatory response?

A

IL4 and IL10

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11
Q

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

A

IL1 and IL6

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12
Q

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

A

Plasminogen activator inhibitor-1

PAI-1

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13
Q

What metabolite is increased as a result of sepsis?

A

Lactic acid (lactate) is a byproduct of bacterial metabolism

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14
Q

Lactate of > ___ is concerning for sepsis.

A

4

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15
Q

A goal in treatment of sepsis is to decrease lactate to

A

5

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16
Q

What is the earliest marker for bacterial infections?

A

Procalcitonin

17
Q

Normal value for procal?

A

<0.15

18
Q

Procal value concerning for sepsis?

A

> 2

19
Q

Where do the majority of sepsis patients come from?

A

ER (37%)

Floor (32%)

20
Q

What is the number 1 cause of sepsis?

A

community acquired pneumonia

21
Q

What are the symptoms of sepsis?

A
Shivering
Extreme pain
Pale or discolored skin
Sleepy, difficult to wake up or confused
I feel like I might die
Short of breath
22
Q

What are the SIRS criteria?

A

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

23
Q

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

A

False, only 1/3

24
Q

Treatment for sepsis?

A
Vanco +carbapenem or vanco + pip/tazo
IV fluids if MAP <65 or lactate>4
Tight glycemic control (insulin drip)
Vasopressors
Sedation
25
Q

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

A

30mL/kg

26
Q

Components of the hour 1 sepsis bundle

A
Lactate
Blood cultures
Antibiotics
Fluid bolus
Maintain MAP with vasopressors
27
Q

First line vasopressor?

A

Norepinephrine

28
Q

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

A

Phenylephrine

29
Q

What vasopressors use is discouraged in sepsis?

A

Dopamine

30
Q

What is the only carbapenem without pseudomonas coverage?

A

Ertapenem

31
Q

CXR findings in ARDS?

A

Bilateral diffuse fluffy infiltrates

32
Q

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

A

Short course of neuromuscular blockers

33
Q

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

A

Nosocomial infections

34
Q

DVT prophylaxis in sepsis patients is done with?

A

Lovenox

35
Q

Stress induced ulcers prevented with what treatment?

A

PPIs or H2 blockers

36
Q

Name the 3 most common bacteria to cause sepsis.

A

Strep pneumo, e. coli, staph aureus