Sepsis

Question 1

What are the SIRS criteria?

Answer 1

1. Temp > 38 or 90

3. RR > 20 or PaCO2 12,000 or

Question 2

What are the criteria for severe sepsis?

Answer 2

Sepsis + organ dysfunction/hypoperfusion

1. Hypotension
2. Oliguria
3. Lactic acidosis
4. AMS

Question 3

What is septic shock?

Answer 3

Sepsis + hypotension that doesn’t respond to fluids

Question 4

What are the three large ideas/goals in early goal directed therapy?

Answer 4

1. Fill the tank
2. Fix the pipes
3. Prime the pump

Question 5

What is the most common cause of sepsis?

Answer 5

Bacterial infection

Question 6

What is the pathogenesis of sepsis?

Answer 6

1. Infection causes activation of inflammatory and coagulation cascades
2. This spreads beyond local site of infection
3. You get hypotension, hypoperfusion, coagulopathy
4. Organs forced into anaerobic metabolism (lactic acidosis)

Question 7

How might sepsis look different at the extremes of age?

Answer 7

1. More likely to be hypothermic

2. Elderly less able to mount tachycardic response

Question 8

What is usually the first indicator of end organ damage in sepsis?

Answer 8

AMS

Question 9

In patients with sepsis, what should you try to obtain before giving fluids (although this shouldn’t delay administration)?

Answer 9

POC Lactate

Question 10

In what patients with sepsis, must you be careful about fluids?

Answer 10

1. CHF

2. Renal failure

Question 11

Immediately after admin of first fluid bolus in sepsis, what should you do?

Answer 11

Reassess. If patient still hypotensive, new lactate > 4, or continued signs of hypoperfusion:

Start EGDT

Question 12

What are the EGDT goals?

Answer 12

1. CVP 8-12 (increase fluids to meet)
2. MAP > 65 (add pressors)
3. Central venous O2 sat > 70 (optimize O2 delivery: PRBC)

Question 13

In sepsis, what is the lactate clearance goal?

Answer 13

> 10% per hour

If it is not reached:

1. PRBC if HCT

Question 14

What are the role of steroids in sepsis?

Answer 14

Becoming more limited as it does not improve overall mortality. Use only if history of prolonged steroid use or other concern for adrenal suppression.

Question 15

What is the role of activated protein C in sepsis?

Answer 15

1. Acute phase reactant that inhibits clots and promotes breakdown
2. Should be given to patients with sepsis-induced organ dysfunction that are deemed to be at high risk of death

Question 16

Glucose goals in sepsis?

Answer 16

Becoming looser (140-180)

Question 17

IVIG in sepsis?

Answer 17

Some studies show benefits in children

Question 18

Statins in sepsis?

Answer 18

Have anti-inflammatory effect

Observational studies show decreased likelihood of death from sepsis

Question 19

ECMO in sepsis?

Answer 19

Unclear results but can be used in patients with cardiorespiratory failure that are refractory to traditional support

Question 20

Lung complications of sepsis?

Answer 20

ARDS (buildup of inflammatory fluid in alveoli)

Try to keep low tidal volumes to limit barotrauma

Question 21

Coagulation complications of sepsis?

Answer 21

DIC

1. Give platelets if