SIRS and Sepsis

Question 1

4 key interventions
*very important

Answer 1

1 ) labs & diagnostics
- include blood cultures and lactate
2 ) antibiotics
- usually broad spectrum
3 ) IV fluids
- bolus (rapid administration)
4 ) monitoring

Question 2

GCS

Answer 2

best response = 15
comatose pt = 8 or less
totally unresponsive = 3

Question 3

SIRS vs Sepsis

Answer 3

sepsis = SIRS + suspected source of infection

Question 4

reasons for increased risk of sepsis

Answer 4

1 ) age (very young vs. very old)
2 ) immuno-suppressant drugs\
- autoimmune, organ transplant
3 ) multiple comorbidities
- chronic diseases
4 ) invasive devices
- central line, parenteral, long-term urinary catheter, indwelling catheter

Question 5

infection source examples

Answer 5

lungs - bronchitis, pneumonia
urinary tract - catheter
abdomen - surgical wounds, diverticulitis, obstructive cholelithiasis or gallbladder inflammation, appendicitis,
skin & soft tissue - cellulitis, ulcers
blood -
central lines - PIC
peritoneal - peronistis

Question 6

septic shock

Answer 6

• severe sepsis w/ hypotension that doesn’t resolve despite IV fluid resuscitation
  hypotension defined as:
• SBP <90mmHg or MAP less than 65 mmHg
  AND/OR
  lactate > or = 2.0 mmol/L

septic shock = sepsis + persistent hypotension

Question 7

1. Labs/ Diagnostics

Answer 7

what labs do we need to ensure are drawn in query sepsis?
- blood cultures
- lactate

what other labs do we need?
- CBC
- inflammatory marker CRP and procalcitonin
- arterial blood gas to measure pH (venous)
- glucose level (goes up in sepsis)

other diagnostic tests are:
- chest x-ray, 12 lead, ECG
- cultures for infection

Question 8

what is lactate?

Answer 8

chemical naturally produced by the body to fuel the cells in times of stress
over 4 mmol/L = 27% mortality rate
guide for determining the severity and determining the effectiveness of the treatment

L-lactate = form associated w/ sepsis

Question 9

3. Antibiotics

Answer 9

what type of antibiotic will be given first?
- broad spectrum

How long do you wait to administer the IV antibiotics if the blood cultures aren’t yet drawn?
- 30 min

when should antibiotics be given?
- if? shock = within an hour
- if no shock = maybe up to 3 hrs

Question 10

2. IV fluids

Answer 10

• initial IV infusion and hydration orders
• ensure at least #2o gauge IV access is in place
• start IV bolus (3omL/kg of IV crystalloid w/in 3h)
• may insert a second IV access in necessary

Note:
repeat vitals, chest ausc and doc prior and following each fluid bolus

Question 11

4. Monitoring

Answer 11

• vital signs and O2 sat Q1h x 6h, then Q4h x 12h
• GCS Q1h x6h
• monitor urine output if able (may insert foley cath as necessary)
• call MD if any deterioration of vs or u/o <25 cc/hr (non-dialysis pt)

call MD and ICU outreach team if:
- RR <10 or >30
- O2 sat <90%
- P <40 or >140
- systolic BP <90 mmHg
- sudden change in LOC

Question 12

critical organs

Answer 12

heart, lungs, brain

less critical:
kidneys = decreased urine output

Question 13

vasopressors and inotropes

Answer 13

norepinephrine
dopamine
vasopressin
- given via central lines or bore IVs

persistent hypotension

Question 14

what other supportive treatments may be given?

Answer 14

1 ) minimizing the risk of hospital acquired infections
2 ) source control
3 ) aggressive pulmonary management
4 ) reducing O2 demand and increasing O2 delivery
5 ) providing early and optimal nutrition
6 ) providing tight glycemic control

Question 15

multiple organ dysfunction syndrome (MODS)

Answer 15

• fine line between septic shock and MODS
• altered function in 2 or more organs

Question 16

MODS S&S

Answer 16

lungs - crackles
liver -
GI tract - hypomobile
kidneys -
brain -
heart -

Question 17

MODS treatment

Answer 17

maintaining adequate tissue oxygenation is the principle target
- best strategy is to prevent MODS
– preventing sepsis