Week 11 - Sepsis Flashcards
Sepsis stats:
- Mortality rate __-__%
- 1 in __ deaths in Canada r/t sepsis
- __th leading cause nationally but __ preventable death worldwide
30-50
18
12, 1
• A systemic inflammatory response to the presence of infection (such as gram positive/neg bacteria, fungi, viruses, mycobacteria or parasites)
sepsis
Sepsis can progress to what conditions?
circulatory systemic dysfunction, multiple organ failure, death
Who is most vulnerable to sepsis? (Age group)
The very young and old
In what proportion of cases is the infectious agent never found for sepsis?
1 in 3
What is the sepsis pathophysiology?
Infection –> ↑inflammation/↑coagulation/↓fibrinolysis –> endothelial dysfunction and microvascular thrombosis –> hypoperfusion ischemia –> acute organ dysfunction
What groups are at increased risk for sepsis?
Immunocompromised (HIV, cancer, corticosteroids, adrenal insufficiency) Burn victims IV drug users catheter surgyer chronic medical conditions (e.g. DM)
What are the 3 big causes/sources of sepsis?
What are some other ones?
Pneumonia, UTI (esp catheters), abdominal/bowel
also, central lines, wounds, artificial ventilation, appendicitis, cellulitis, meningitis, endocarditis
What are the different SIRS criteria?
temp above 38 or below 36 HR above 90 resp rate above 20 pCO2 over 32 torr WBC count > 12 or > 10% of immature WBC hyperglycemia and abnormal clotting/bleeding
When there is a higher immature WBC count
left shift
what cell type is mostly released in a left shift?
neutrophils
What does the SEPSIS acronym stand for?
Shivering, fever or cold extreme pain or general discomfort Pale or discoloured skin Sleepy, difficult to wake or confused I feel like I might die Shortness of breath
What is sepsis when SIRS criteria are used?
infection + two or more SIRS signs
In severe sepsis, what other clinical signs and symptoms (other than organ dysfunction, hypotension or hypoperfusion) will also manifest?
Lactic acidosis oligouria thrombocytopenia altered hepatic function altered LOC
What is the order of management for severe sepsis?
Oxygen, blood cultures, Abx, blood draws, remove infectious source, fluid resuscitation
What is oligouria and what precedes it?
400/500mL/24 hours
elevated CR first
characterized by symptoms of sepsis plus hypotension despite adequate fluid resuscitation
septic shock
if septic shock is left unchecked, what can it lead to?
MODS - multiple organ dysfunction
What are the CV signs of MODS?
o Arrhythmias, cyanosis, cold extremities, hypotension, weak/thread pulse (if a radial pulse is felt – minimum BP is 80 SBP)
MAP – 2x diastolic BP + SBP / 3 if less than 60 (bad)
What are the Respiratory signs of MODS?
o Cyanosis, tachypnea early, greater use of accessory muscles, air hunger,
o ABGs - ↑CO2, ↓O2
What are the renal signs of MODS?
decreased urine output, oligouria/anuria, increased Cr, WBCs in urine; hyperglycemia
What are hemotological signs of MODS?
o Clotting, but not clotting, o ↑WBCs o ↓Ptts (platelets) o ↑CRP o ↑bilirubin (jaundiced)
What are GI signs of MODS?
o DBS
o Ischemia
o Rest and digest inhibited
What are hepatic signs of MODS?
o Lower function, AST and ALT elevated
What are neurological signs of MODS?
o Decreased LOC, confusion, lethargy, psychosis – keep in mind baseline
What is the order for pressors to give to septic shock patients?
NE first, followed by epi, then vasopressin (must co-admin with NE)
Do not really give dopamine or dobutamine
How do we check blood gases?
9 times out of 10 we don’t do ABGs, but venous gases instead
What level would a septic patient be placed?
C test 2 - second highest level
What is the SSC sepsis bundle?
Things to do within 1 hour:
- Measure lactate level
- Obtain blood cultures prior to admin of Abx
- Administer broad spectrum Abx
- Administer 500 mL bolus then 30 mL/kg crystalloid for hypotension or lactate greater than/equal to 4 mmol/L
- Vasopressors initiated should the BP not increase after fluids
Describe blood cultures in sepsis.
BC before Abx
- start broad spectrum until results come back
draw from two different sites (two peripheral or one peripheral and one central)
What fluids do we use for sepsis?
NS (sometimes RL)
Stay away from D5
For bacterial caused sepsis, what blood level will increase, as an indicator of inflammation?
PCT - pro-calcitonin
How often do we do BC for septic patients?
Once x2, then q72
redraw if fever hasnt gone down
What are the different sections of the sepsis screening tool?
A - are any two of the following Sx present and new to the patient? (SIRS stuff)
B - Does the patient have a known or suspected infection?
C - is any one of the following present (vitals, CBC, urine output)
D - sepsis determination
