Sepsis Spectrum Flashcards
what does SIRS stand for?
systemic inflammatory response syndrome
what can cause SIRS?
- post operative
- infection
- trauma
- acute inflammation or ischemia or reperfusion
- malignancy
what is the criteria for SIRS?
> =2 of the below
1. temperature >38 or <36
2. HR >90/min
3. RR > 20/min or PaCO2 <32 mmHg
4. WBCs >12,000/mm3 or < 4000/mm3 +/- >10% bands
what is the definition of SIRS?
Exaggerated defense response of the body to a noxious stressor
what is sepsis vs severe sepsis vs septic shock?
Sepsis: SIRS + confirmed or suspected infection
Severe sepsis: sepsis + s/s of end-organ damage/hypoperfusion/hypotension (lactic acidosis; SBP <90 or SBP drop >=40 mmHg of normal)
Septic shock: severe sepsis w/ persistent hypotension despite adequate fluid resuscitation
what is multiple organ dysfunction syndrome (MODS)?
evidence of >= 2 organs failing; homeostasis is not maintainable w/o intervention
what are RF for sepsis?
- hospital or ICU admission
- immunosuppression/comorbidities - HIV/AIDS, hematologic malignancy, DM, cirrhosis, alcoholism
- recent surgery/hospitalization ➔ altered microbiome
- indewelling medical device ➔ catheters, endotracheal tubes, IVs, ports
- age, <5Y or >65Y
- recent abx use or steroid use
what is the pathophys of the consequences of sepsis?
- exposure – bacterial or viral
- local rxn at site of injury
- bacteremia - bacteria in the blood OR local
- systemic inflammatory response ➔ increase in proinflammatory factors over anti-inflammatory factors
- proinflammatory factors ➔ cytokines
- increased vascular permeability and systemic vasodilation
- third-spacing ➔ edema + decrease in intravascular volume
- hypotension ➔ hypoperfusion ➔ end organ damage
- cytokine release also triggers (prothrombotic) coagulation which results in microthrombi ➔ DIC and clots
- overtime, there is immunosuppression bc anti-inflammatory has overcompensated for the proinflammatory state ➔ more suseptible to nosocomial infections
how does someone with sepsis typically present?
s/s of infection
- fever, tachycardia, tachypnea, hypotension, hypoxemia, decrease UO, edema, altered mental status
s/s of shock: cool skin, cyanosis, increase cap refill time, mottling (blotchy, red-purplish marbling of the skin)
End organ damage s/s
- liver ➔ jaundice
- brain ➔ ALoC
- lungs ➔ ALoC, cyanosis, ARDS
- kidneys ➔ oliguria (prerenal AKI)
what is warm shock?
shock is still compensated by increased HR and CO to circulate blood and maintain BP
with aggressive management w/ fluids and vasoactive support, can be reversed
what is cold shock?
shock is decompensated w/ hypotension and cool extremities, prolonged cap refill, tready pulse, bc blood flow is not happening
may be irreversible and progress into MODS
what is the sepsis six (BUFALO)?
give 3, take 3
B - blood culture x2
U - urine output monitoring
F - IV fluids
A - IV antibiotics
L - serum lactate
O - oxygen
how would you approach a sepsis pt?
- ABC – give oxygen, IV fluids (30mL/kg of balanced crystalloids; usually 2-3L total) ➔ IV access
- consider vasopressors if not responsive to fluids (target is MAP >65 mmHg) ➔ norepinephrine ➔ if requiring continued vasopressors, consider adding IV corticosteroids
- source identification: blood culture x2, swab any potential source of infection (lines, urine analysis, tracheal if intubated, sputum)
- empiric broad spectrum abx (within the first hour)
- complete other bloodwork and imaging
- CBC w/ diff
- serum lactate
- creatinine and urea ➔ ?AKI
- ALT/ALP/GGT and bilirubin and albumin ➔ liver function
- PT/INR ➔ DIC
- group and screen ➔ potential need for transfusion
- ABG/VBG
- electrolytes
- POC glucose
- viral swabs
- CXR ➔ ?pneumonia
- AXR ➔ ?abscess or fluid collection
- ECG/telemetry
- consider LP for CSF analysis if suspect meningitis or encephalitis - continue monitoring and adjust accordingly
what would empiric abx be for GP coverage?
vancomycin
what would empiric abx be for GN coverage?
broad-spec penicillins (pip-tazo)
