Sepsis, SIRS, and MODS

Question 1

Sepsis

Answer 1

Constellation of symptoms in response to infection
Dysregulated response and new organ dysfunction related to infection
Body’s extreme response to infection

Question 2

Criteria for sepsis

Answer 2

Suspected or confirmed **infection* and usually 2 of the following:
Fever >100.9
Hypothermia <97
HR >90
Tachypnea >22
SBP <100
Altered MS
Edema
Hyperglycemia >140 without diabetes
WBC >12,000
WBC <4,000
Arterial hypotension
Oliguria
Serum creatinine increase
Coagulation abnormalities
Absent bowel sounds
Thrombocytopenia
Hyperbilirubinemia
Increased capillary refill or mottling

Question 3

MAP

Answer 3

MAP of 60 needed for adequate perfusion

> 65 indicated for sepsis/septic shock

Question 4

Risk factors for sepsis

Answer 4

Immunosuppression (cancer, HIV/AIDS, transplant, steroids, lupus)
Extremeties of age
Malnourishment
Chronic illness (diabetes, hepatitis, CKD)
Invasive procedures
Emergent and/or multiple surgeries

Question 5

Treatment for sepsis

Answer 5

1 hour bundle

Obtain lactate and blood cultures x2
Administer broad spectrum antibiotics
Crystalloid LR for hypotension or lactate >4
Vasopressors to maintain MAP >65
Remeasure lactate if initial is elevated >2

Question 6

Lactate

Answer 6

Causes metabolic acidosis

Question 7

Blood cultures

Answer 7

2 sites, follow facility policy
Must fill bottle to what is labeled

Draw cultures before administering ABX

Draw aerobic first

Question 8

IV Fluids

Answer 8

Crystalloids, usually LR because closer to blood’s pH
30 ml/kg for initial fluid resuscitation
Large bore IV (20G+)
Watch for IV infiltration, SOB, blood pressure response

Question 9

Vasopressors

Answer 9

Used to support blood pressure
Must be in the ICU and administered through central line
Presses blood back to the heart to increase BP and increase contractibility of heart and increase MAP

Question 10

Predicting Mortality qSOFA

Answer 10

Quick Sepsis-Related Organ Failure Assessment
2 or more criteria is positive, another tool is MEWS

Altered mental status
Respiratory rate >/= 22
Systolic BP </= 100 mmHg

Question 11

SIRS

Answer 11

Generalized inflammation in organs remote from initial insult
Causes:
Sepsis/microbial invasion
Trauma
Abscess formation
Ischemia or necrotic tissue
Post cardiac arrest
Shock states

GOAL: PREVENT PROGRESSION

If not prevented, leads to shock/MODS

Question 12

SIRS Criteria

Answer 12

Tachycardia >90bpm
*Tachypnea >20)
Fever or hypothermia
Leukocytosis, leukopenia, or bandemia

Patients with 2 or more meet SIRS criteria
Patient with infection and 2 or more SIRS factors have sepsis

Don’t need to have infection to meet SIRS criteria

Question 13

Preventing CLABSIs

Answer 13

Remove central line when it is no longer needed
Inserted with sterile techniques
Clean gloves and hand hygiene before accessing
Change dressing every 7 days or when soiled using sterile technique
MHG bath daily
Obtain provider order for blood draws
Change caps after each blood draw, blood administration, and daily with TPN