Sepsis/ Shock

Question 1

Systemic inflammatory response syndrome (SIRS)

Answer 1

Dysregulated inflammatory response

Presence of two or more of the following:

Temperature >38C (100.4oF) or <36C (96.8oF)

Heart rate >90 beats/min

Respiratory rate >20 breaths/min

WBC >12,000 cells/mm3, <4000 cells/mm3, or >10 percent immature (band) forms

Question 2

Systemic inflammatory response syndrome (SIRS) can arise from

Answer 2

A number of different conditions

 Vasculitis

 Burns

 Surgery

 Myocardial infarction

 Pulmonary embolus, fat or amniotic fluid embolism

 Acute pancreatitis

 Acute gastrointestinal hemorrhage

 Transfusion reactions

 Adverse drug reactions

Question 3

Sepsis =

Answer 3

Sepsis = SIRS + Infection

Question 4

Severe sepsis

Answer 4

Hypotension

Systolic blood pressure <90 mmHg

>40 mm Hg from baseline

Reversible with intravenous fluid resuscitation

Question 5

Septic shock =

Answer 5

Sepsis not responding to IVF resuscitation

 Requires vasopressors

Question 6

Multiorgan failure (MOF), Multiple Organ Dysfunction Syndrome (MODS)

Answer 6

Physiological dysfunction in ≥2 organ systems as a result of sepsis

 Respiratory

 Renal

 Coagulation

 Cardiovascular

 Bone marrow

 Hepatic

 CNS

Question 7

Multiorgan failure (MOF), Multiple Organ Dysfunction Syndrome (MODS)

Mortality

Answer 7

Question 8

Sepsis epi # COD

Answer 8

10

Question 9

Increasing caues of sepsis

Answer 9

 Staphylococcus aureus

 Coagulase-negative staphylococci

 Enterococci

 Increasing rates of fungal sepsis

Question 10

Gram positive bacteria

Virulance factors

Answer 10

Peptidoglycan

 Lipoteichoic acid

Question 11

Gram negative bacteria

virulance factors

Answer 11

 Lipopolysaccharide (LPS)

 Endotoxin

Question 12

What is the most powerful immune stimuli

Answer 12

LPS

Question 13

Cardiovascular changes during sepsis

Answer 13

Vasodilatation, Low SVR

Intravascular volume depletion, hypoperfusion Tachycardia, Increased cardiac output

Eventual decreased myocardial contractility, Hypotension (sepsis -> severe sepsis)

Question 14

Pulmonary changes in sepsis

Answer 14

Vascular permeability

Noncardiogenic pulmonary edema

Question 15

Renal changes in sepsis

Answer 15

Decrease effective intravascular volume due to

systemic hypotension -> Acute tubular necrosis

Question 16

Central nervous system dysfunction during sepsis

Answer 16

Hypotension can lead to brain hypoperfusion.

Result of hepatic or renal dysfunction, metabolic encephalopathy

Question 17

Why is there hypotension during shock

Answer 17

Vasodilatation, capillary leak, hypovolemia → hypotension and poor tissue perfusion

Question 18

BACTEREMIA:

Etiology

Answer 18

Secondary to primary focus of infection

 Usually transient: Skin- Abscess; GU- Pyelonephritis;

Pulmonary- Pneumonia

Endovascular source -> Usually sustained

 Infected intravascular device- (Catheter) Endocarditis

Question 19

BACTEREMIA complications

Answer 19

 Metastatic seeding

 Vertebral osteomyelitis/diskitis

Infect foreign devices

 Septic emboli- Lung, Brain, Skin

 Endocarditis

Question 20

Risk factors endocarditis

Answer 20

Structural heart disease Stenosis, sclerosis, prolapse Prosthetic valve

 Rheumatic

 IVDU

 Congenital

VSD, bicuspid AV

Question 21

Organisms related to endocarditis

Answer 21

staph, viridans strep, enterococcus