SEPSIS/SEPTIC SHOCK Flashcards
It is a subset of sepsis cases in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality risk.
Septic Shock
It is a dysregulated host response to infection that leads to acute organ dysfunction
Sepsis
The Sepsis-3 clinical criteria for sepsis include?
1) A suspected infection and
2) Acute organ dysfunction, defined as an increase by two or more points from baseline (if known) on the sequential (or sepsis-related) organ failure assessment (SOFA) score
The most common gram-positive isolates in sepsis?
Staphylococcus aureus
Streptococcus pneumoniae
The most common gram negative isolates?
Escherichia coli
Klebsiella species
Pseudomonas aeruginosa
TRUE OR FALSE:
Pro-inflammatory reactions (directed at eliminating pathogens) are responsible for “collateral” tissue damage in sepsis
It is a common PAMP that is found in the outer membrane of gram-negative bacteria
lipid A moiety of lipopolysaccharide (LPS or endotoxin)
Two of the most commonly affected organ systems in sepsis
respiratory and cardiovascular systems
Respiratory compromise classically manifests as_____?
acute respiratory distress syndrome (ARDS).
It is defined as hypoxemia and bilateral infiltrates of noncardiac origin that arise within 7 days of the suspected infection
* Mild (Pao2/Fio2, 201–300 mmHg)
* Moderate (101–200 mmHg)
* Severe (≤100 mmHg)
Cardiovascular compromise typically presents as _______?
hypotension
TRUE OR FALSE: Arterial lactate is a long-studied marker of tissue hypoperfusion, and hyperlactemia and delayed lactate clearance are associated with a greater incidence of organ failure and death in sepsis.
TRUE
TRUE OR FALSE: For every 1-h delay among septic patients, a 3−7% increase in the odds of in-hospital death is reported.
TRUE
Clinical practice guidelines recommend the administration of appropriate broad-spectrum antibiotics within how many hours of recognition of sepsis or septic shock
1 hour
- 1 HOUR BUNDLE OF CARE
- measurement of serum lactate levels
- collection of blood for culture before antibiotic administration
- administration of appropriate broad-spectrum antibiotics
- initiation of a 30 mL/kg crystalloid bolus for hypotension or lactate ≥4 mmol/L,
- treatment with vasopressors for persistent hypotension or shock
TRUE OR FALSE: Beta lactams may exhibit unpredictable pharmacodynamics in sepsis, therefore continuous infusion is recommended
TRUE
Initial antimicrobial therapy in splenectomized patients with severe sepsis?
Ceftriaxone
The recommended target MAP in patients with septic shock?
> /= 65mmHg
The recommended first choice vasopressor in patients with septic shock?
Norepinephrine
Which additional antibiotics should be considered in neutropenic patients with suspected central-line–associated bloodstream infection or severe mucositis?
A) Tobramycin and Vancomycin
B) Metronidazole and Clindamycin
C) Linezolid and Daptomycin
D) Trimethoprim-Sulfamethoxazole and Rifampin
Answer: A) Tobramycin and Vancomycin
Rationale: In neutropenic patients with high-risk infections, vancomycin is added for MRSA coverage, and tobramycin (or another aminoglycoside) is used for enhanced Gram-negative coverage.
In a patient with asplenia (splenectomy), what is the recommended first-line antibiotic regimen for severe sepsis?
A) Ceftriaxone (2 g q24h) + Vancomycin
B) Cefazolin (1 g q8h) + Doxycycline
C) Ampicillin-sulbactam (1.5 g q6h) + Metronidazole
D) Azithromycin + Clindamycin
Answer: A) Ceftriaxone (2 g q24h) + Vancomycin
Rationale: Patients with asplenia are highly susceptible to encapsulated bacteria (e.g., Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis), so ceftriaxone is the preferred choice, with vancomycin added if a resistant strain is suspected.
A patient with severe sepsis and a history of splenectomy is allergic to beta-lactam antibiotics. What is an appropriate alternative regimen?
A) Levofloxacin (750 mg q24h) + Vancomycin
B) Gentamicin + Metronidazole
C) Clindamycin + Azithromycin
D) Nitrofurantoin + Rifampin
Answer: A) Levofloxacin (750 mg q24h) + Vancomycin
Rationale: Levofloxacin (a fluoroquinolone) can be used in beta-lactam–allergic patients, while vancomycin is added for Gram-positive coverage. Other options do not provide adequate broad-spectrum coverage.
Which of the following statements is TRUE regarding resuscitation in sepsis and septic shock?
A) Hydroxyethyl starches are preferred over crystalloids for resuscitation.
B) Dopamine is the first-choice vasopressor for septic shock.
C) Red blood cell transfusion is recommended when hemoglobin drops below 7.0 g/dL, except in certain conditions.
D) The recommended target mean arterial pressure (MAP) is 75 mmHg.
Answer: C) Red blood cell transfusion is recommended when hemoglobin drops below 7.0 g/dL, except in certain conditions.
Rationale: Crystalloids are preferred over hydroxyethyl starches. Norepinephrine, not dopamine, is the first-choice vasopressor. The target MAP is 65 mmHg, not 75 mmHg.
When should IV antibiotics be initiated in patients with sepsis?
A) Only after microbiological cultures confirm an infection
B) Within 1 hour of suspected sepsis
C) After 6 hours of hemodynamic stabilization
D) Once source control has been performed
Answer: B) Within 1 hour of suspected sepsis
Rationale: Early administration of IV antibiotics is crucial in sepsis. Delayed treatment increases mortality risk.
In mechanically ventilated patients with sepsis-induced ARDS, what is the recommended tidal volume?
A) 4 mL/kg of predicted body weight
B) 6 mL/kg of predicted body weight
C) 8 mL/kg of predicted body weight
D) 12 mL/kg of predicted body weight
Answer: B) 6 mL/kg of predicted body weight
Rationale: Lower tidal volumes (6 mL/kg) are recommended to reduce ventilator-induced lung injury in ARDS.
Which of the following is NOT recommended in sepsis management?
A) Routine use of a pulmonary artery catheter
B) Early administration of broad-spectrum antibiotics
C) Blood glucose control with insulin when glucose exceeds 180 mg/dL
D) Prone positioning for severe ARDS
Answer: A) Routine use of a pulmonary artery catheter
Rationale: Pulmonary artery catheters are not routinely recommended due to a lack of evidence supporting improved outcomes.
