Sepsis, SIRS, MODS

Question 1

What is diagnostic criteria for SIRS in cats?

Answer 1

• ≥ 3 criteria
• High or low temp
• Tachycardia OR Bradycardia
• Tachypnea
• high or low WBCs

Question 2

What is diagnostic criteria for SIRS in cats?

Answer 2

• ≥ 2 criteria
• High or low temp
• Tachycardia
• Tachypnea
• high or low WBCs
• > 3% bands

Question 3

What is true about the SIRS criteria for dogs and cats?

Answer 3

Highly sensitive but not specific

Question 4

What is the definition of septic shock?

Answer 4

• Sepsis induced hypotension that is persistent/refractory despite adequate fluid therapy

Question 5

What is the host response to SIRS?

Answer 5

Activation of cytokines (cytokine storm)

Question 6

True or False: Septic patients have SIRS

Answer 6

TRUE

Question 7

Which of the following should be targeted in a patient with hypotension refractory to fluid therapy?

A. Preload
B. Contractility
C. Systemic vascular resistance
D. Oxygen consumption

Answer 7

C. Systemic vascular resistance

give vasopressors!!

Question 8

What is a normal lactate value in dogs and cats?

Answer 8

< 2-2.5

Question 9

Shock is a syndrome where _________

Answer 9

Delivery of O2 is insufficient to meet cellular metabolic needs

Question 10

What occurs on an oxyhemoglobin dissociation curve in patients with sepsis?

Answer 10

• Sepsis causes a RIGHT shift
• This is an attempt for Hb to deliver O2 to tissues more readily

(Increased metabolic requirements during sepsis)

Question 11

When are vasopressors indicated for patients with sepsis?

Answer 11

Septic shock / Refractory hypotension despite adequate fluid therapy

Question 12

When are antibiotics indicated for suspect sepsis patients?

Answer 12

• If 2 criteria of SIRS
• If 3 criteria of SIRS
• Ideally give Abxs within 1 hour of sepsis identification or if highly suspected

Question 13

What criteria is used to determine if the renal system is affected by MODS?

Answer 13

• Increased Creatinine
• Oliguria UOP < 1-2 mL/kg/hr

Question 14

What criteria is used to determine if the hepatic system is affected by MODS?

Answer 14

• Increased tbili
• Increased ALT

Question 15

What criteria is used to determine if coagulation is affected by MODS?

Answer 15

• Increased PT/PTT
• Thrombocytopenia
• Evidence of DIC

Question 16

What is the 2 hit model? Provide an example

Answer 16

• Primary insult → secondary hit → exaggerated inflammatory response

Ex: Presenting with trauma and later developing secondary aspiration pneumonia

Question 17

What is the 1-hit model?

Answer 17

• Result of a massive initial insult
• Ex: trauma (HBC), septic peritonitis, heat stroke

Question 18

What is the sustained hit model?

Answer 18

Continuous smoldering insult causes and sustains MODS

Ex: MDR bacterial infection

Question 19

What is the most current definition of sepsis?

Answer 19

SIRS + infection + evidence of new organ dysfunction

Question 20

What are considered end points of resuscitation?

Answer 20

• HR normalizes
• Improved pulse quality
• Lactate clearance
• Normotensive BP
• Normal CRT

Question 21

In regards to treatment plan in a septic patient, what can negatively impact survival?

Answer 21

Delayed empirical antibiotic treatment