Test #2 Sepsis ARTICLES - Rude man

Question 1

Define bacteremia.

Answer 1

presence of bacteria in the bloodstream

Question 2

Define septicemia.

Answer 2

the presence of large numbers of baceria in the bloodstream often associated with systemic signs and symptoms such as fever, rigors, and headache

Question 3

Define systemic inflammatory response syndrome (SIRS).

Answer 3

the threshold definition is two or more of the following:

• temp > 38 C or < 36 C
• HR > 90
• RR > 20 or PaCO2 < 32
• WBC < 4 or > 12 or > 10% immature forms

Question 4

Define sepsis.

Answer 4

SIRS with clinical evidence of infection

Question 5

Define severe sepsis.

Answer 5

sepsis associated with organ dysfunction, hypotension, or hypoperfusion abnormalities

Question 6

Define septic shock.

Answer 6

sepsis-induced hypotension, despite fluid resuscitation, plus hypoperfusion abnormalities

Question 7

Define sepsis-induced hypotension.

Answer 7

a systolic arterial pressure < 90mmHg or a reduction of > 40mmHg from baseline in the absence of other causes for hypotension

Question 8

In high-risk surgical or trauma patients with sepsis, early hemodynamic optimization before the development of organ failure reduced mortality by _____ % in comparison with those who were optimized after the development of organ failure.

Answer 8

23%

Question 9

After the diagnosis of severe sepsis or septic shock is made, should you wait for cultures to come back before you start antibiotics?

Answer 9

no, IV antibiotics should be started as early as possible.

broad-spectrum agents should be used initially with one or more agents active against all likely bacterial/fungal pathogens.

Question 10

The first 6 hours of resuscitation of septic patients are called the _______ _______.

Answer 10

golden showers… i mean, hours

golden hours

Question 11

When volume resuscitating a hypotensive septic patient with crystalloids or colloids, what clinical endpoints do you aim for? (4)

Answer 11

• CVP 8-12 mmHg
• MAP 65 mmHg
• UOP 0.5 mL/kg
• SvO2 >70%

Question 12

What is the first line inotrope therapy to be added to vasopressor in a septic patient?

Answer 12

dobutamine

Question 13

When should fluid administration be stopped?

Answer 13

when filling pressures are high and no further improvement is seen in tissue perfusion (eg. serum lactate isn’t decreasing)

Question 14

Since these patients are in an inherently unstable cardiovascular state, how would you go about doing induction of anesthesia? (kind of a vague question, i know)

Answer 14

in a deliberate step-wise process, using small doses of IV anesthetic agents, titrated to clinical response

Question 15

Is MAC increased or decreased in severe sepsis?

Answer 15

decreased

if the patient has significant lung dysfunction, it’s better to use IV agents instead of inhalation agents

Question 16

What two lab values would indicate adequacy of global oxygen delivery?

Answer 16

• serum lactate < 2

- mixed venous O2 sat > 70%

Question 17

Hypercarbia should be avoided specifically in these patients. (3)

Answer 17

• raised ICP
• compensated metabolic acidosis
• someone in the later stages of pregnancy

Question 18

What is the term for the difference between the pressure inside and outside the alveolar air space at end-inspiration?

Answer 18

transpulmonary pressure

(when an end-inspiratory pause has been applied, it is an indicator of the maximal pressure applied inside the alveolar sac)

Question 19

Transpulmonary pressure should be limited to _____ - ______ cm H2O to minimize lung parenchymal ventilatory damage.

Answer 19

25 - 30 cm H20