Severe sepsis and septic shock

Question 1

SIRS

Answer 1

(1) fever (oral temperature >38°C) or hypothermia (24 breaths/min);
(3) tachycardia (heart rate >90 beats/min);
(4) leukocytosis (>12,000/ L), leucopenia (10% bands;

Question 2

Sepsis

Answer 2

SIRS that has a proven or suspected microbial etiology

Question 3

Severe sepsis:

cardiovascular

Answer 3

arterial systolic blood pressure 90mmHg or mean arterial pressure 70mmHg that responds to administration of intravenous fluid

Question 4

Severe sepsis:

renal

Answer 4

Urine output <0.5 mL/kg per hour for 1 h despite adequate fluid resuscitation

Question 5

Severe sepsis:

Respiratory:

Answer 5

PaO2/FIO2 250or, if the lung is theonlydysfunctionalorgan, 200

Question 6

Severe sepsis:

Unexplained metabolic acidosis

Answer 6

ApH 7.30 or a base deficit 5.0mEq/Landa plasma lactate level >1.5 times upper limit of normal for reporting lab

Question 7

Severe sepsis

Adequatefluidresuscitation

Answer 7

Pulmonaryarterywedgepressure 12mmHgor centralvenouspressure 8mmHg

Question 8

Septic shock

Answer 8

Sepsis with hypotension (arterial blood pressure s normal blood pressure) for at least 1 h despite adequate fluid resuscitation; or
Need for vasopressors to maintain SBP 90 or MAP 70mmHg

Question 9

Refractory Septic Shock

Answer 9

Septic shock that lasts for >1 h and does not respond to fluid or pressor administration

Question 10

Multiple-organ dysfunction syndrome (MODS)

Answer 10

Dysfunction of more than one organ, requiring intervention to maintain homeostasis

Question 11

MC cause sepsis

Answer 11

Gram-negative bacteria

Enterobacteriaceae, pseudomonads, Haemophilus spp., other gram-negative bacteria.

Question 12

Gram pos bacteria sepsis

Answer 12

staphylococcus aureus, coagulase-negative staphylococci, enterococci, Streptococcus pneumoniae,
other streptococci, other gram-positive bacteria.

Question 13

adrenal insufficiency

Answer 13

plasma cortisol level of 15 g/mL ( 10 g/mL if the serum albumin concentration is <2.5 mg/dL

Question 14

Rx sespis immunocompetent

Answer 14

1) piperacillin-tazobactam (3.375 g q4 –6h);
(2) imipenem-cilastatin (0.5 g q6h) or meropenem (1 g q8h); or
(3) cefepime (2gq12h).
(+) allergy Blactams: ciprofloxacin(400mg q12h) or levofloxacin (500–750 mg q12h) plus clindamycin (600 mg q8h).

Question 15

Rx Neutropenia (<500 neutrophils/ L)

Answer 15

(1) imipenem-cilastatin
meropenem (1 g q8h) or
cefepime (2 g q8h);
(2) piperacillintazobactam (3.375 g q4h) plus tobramycin (5–7 mg/kg q24h). Vancomycin (15 mg/kg q12h) should be added if the patient has an indwelling vascular catheter,

Question 16

Rx sepsis splenectomy

Answer 16

Cefotaxime

ceftriaxone

Question 17

first drug to be approved by the U.S. Food and Drug Administration for the treatment of patients with severe sepsis or septic shock

Answer 17

Recombinant activated protein C (aPC)