Week 11 - Sepsis

Question 1

Sepsis stats:

• Mortality rate __-__%
• 1 in __ deaths in Canada r/t sepsis
• __th leading cause nationally but __ preventable death worldwide

Answer 1

30-50
18
12, 1

Question 2

• A systemic inflammatory response to the presence of infection (such as gram positive/neg bacteria, fungi, viruses, mycobacteria or parasites)

Answer 2

sepsis

Question 3

Sepsis can progress to what conditions?

Answer 3

circulatory systemic dysfunction, multiple organ failure, death

Question 4

Who is most vulnerable to sepsis? (Age group)

Answer 4

The very young and old

Question 5

In what proportion of cases is the infectious agent never found for sepsis?

Answer 5

1 in 3

Question 6

What is the sepsis pathophysiology?

Answer 6

Infection –> ↑inflammation/↑coagulation/↓fibrinolysis –> endothelial dysfunction and microvascular thrombosis –> hypoperfusion ischemia –> acute organ dysfunction

Question 7

What groups are at increased risk for sepsis?

Answer 7

Immunocompromised (HIV, cancer, corticosteroids, adrenal insufficiency)
Burn victims
IV drug users
catheter surgyer
chronic medical conditions (e.g. DM)

Question 8

What are the 3 big causes/sources of sepsis?

What are some other ones?

Answer 8

Pneumonia, UTI (esp catheters), abdominal/bowel

also, central lines, wounds, artificial ventilation, appendicitis, cellulitis, meningitis, endocarditis

Question 9

What are the different SIRS criteria?

Answer 9

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

Question 10

When there is a higher immature WBC count

Answer 10

left shift

Question 11

what cell type is mostly released in a left shift?

Answer 11

neutrophils

Question 12

What does the SEPSIS acronym stand for?

Answer 12

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

Question 13

What is sepsis when SIRS criteria are used?

Answer 13

infection + two or more SIRS signs

Question 14

In severe sepsis, what other clinical signs and symptoms (other than organ dysfunction, hypotension or hypoperfusion) will also manifest?

Answer 14

Lactic acidosis
oligouria
thrombocytopenia
altered hepatic function
altered LOC

Question 15

What is the order of management for severe sepsis?

Answer 15

Oxygen, blood cultures, Abx, blood draws, remove infectious source, fluid resuscitation

Question 16

What is oligouria and what precedes it?

Answer 16

400/500mL/24 hours

elevated CR first

Question 17

characterized by symptoms of sepsis plus hypotension despite adequate fluid resuscitation

Answer 17

septic shock

Question 18

if septic shock is left unchecked, what can it lead to?

Answer 18

MODS - multiple organ dysfunction

Question 19

What are the CV signs of MODS?

Answer 19

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)

Question 20

What are the Respiratory signs of MODS?

Answer 20

o Cyanosis, tachypnea early, greater use of accessory muscles, air hunger,
o ABGs - ↑CO2, ↓O2

Question 21

What are the renal signs of MODS?

Answer 21

decreased urine output, oligouria/anuria, increased Cr, WBCs in urine; hyperglycemia

Question 22

What are hemotological signs of MODS?

Answer 22

o	Clotting, but not clotting, 
o	↑WBCs
o	↓Ptts (platelets)
o	↑CRP
o	↑bilirubin (jaundiced)

Question 23

What are GI signs of MODS?

Answer 23

o DBS
o Ischemia
o Rest and digest inhibited

Question 24

What are hepatic signs of MODS?

Answer 24

o Lower function, AST and ALT elevated

Question 25

What are neurological signs of MODS?

Answer 25

o Decreased LOC, confusion, lethargy, psychosis – keep in mind baseline

Question 26

What is the order for pressors to give to septic shock patients?

Answer 26

NE first, followed by epi, then vasopressin (must co-admin with NE)
Do not really give dopamine or dobutamine

Question 27

How do we check blood gases?

Answer 27

9 times out of 10 we don’t do ABGs, but venous gases instead

Question 28

What level would a septic patient be placed?

Answer 28

C test 2 - second highest level

Question 29

What is the SSC sepsis bundle?

Answer 29

Things to do within 1 hour:

1. Measure lactate level
2. Obtain blood cultures prior to admin of Abx
3. Administer broad spectrum Abx
4. Administer 500 mL bolus then 30 mL/kg crystalloid for hypotension or lactate greater than/equal to 4 mmol/L
5. Vasopressors initiated should the BP not increase after fluids

Question 30

Describe blood cultures in sepsis.

Answer 30

BC before Abx
- start broad spectrum until results come back
draw from two different sites (two peripheral or one peripheral and one central)

Question 31

What fluids do we use for sepsis?

Answer 31

NS (sometimes RL)

Stay away from D5

Question 32

For bacterial caused sepsis, what blood level will increase, as an indicator of inflammation?

Answer 32

PCT - pro-calcitonin

Question 33

How often do we do BC for septic patients?

Answer 33

Once x2, then q72

redraw if fever hasnt gone down

Question 34

What are the different sections of the sepsis screening tool?

Answer 34

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