Sepsis

Question 1

Although SIRS has been shown to have poor sensitivity and specificity, it is still widely used. What are the SIRS criteria?

Answer 1

• Temperature greater than 38ºC or less than 36ºC
• HR greater than 90 BPM
• RR greater than 20 or PaCO2 less than 32 mm Hg
• WBC greater than 12,000 or less than 4,000 or greater than 10% immature bands

Question 2

What is sepsis?

Answer 2

A syndrome in which the patient meets the SIRS criteria and has a potential infectious source

Question 3

What is severe sepsis?

Answer 3

Sepsis with signs of end-organ dysfunction such as any one of the following:
•SBP less than 90 mm Hg or a drop in 40 mm Hg from baseline
•Creatinine greater than 2.0 mg/dl or decreased urine output (less than 0.5 ml/kg/hour for greater than 2 hours)
•Bilirubin greater than 2.0 mg/dl
•Platelet count less than 100,000
• INR greater than 1.5 or aPTT greater than 60 seconds
•Lactate greater than 2 mM

Question 4

What is septic shock?

Answer 4

Persistently low blood pressure with severe sepsis despite fluid resuscitation at 30 ml/kg

Question 5

One of the best indicators of risk stratification for sepsis patients is ______________.

Answer 5

lactate elevation; higher levels predict worse mortality

Question 6

What tests should be ordered in suspected sepsis?

Answer 6

• CBC w/differential
• CMP
• CXR
• Urine and blood cultures
• PT/INR/PTT

Question 7

How is sepsis treatment monitored?

Answer 7

With serial lactates

Question 8

In general, when should antibiotics be administered in suspected sepsis?

Answer 8

As soon as possible. Some studies found differences if given within one hour, but other studies showed no difference if given anytime within five hours.

Question 9

What does the three-hour sepsis bundle comprise?

Answer 9

• Lactate measurement
• Blood cultures drawn before antibiotic administration
• 30 ml/kg fluid bolus
• Antibiotics started

Question 10

What does the six-hour sepsis bundle comprise?

Answer 10

• Reassess volume status after fluid administration
• Administer vasopressors for hypotension that does not respond to initial fluid administration
• Redraw lactate

Question 11

“___________ should be considered the ECG of sepsis.” –CDEM on sepsis

Answer 11

Lactate

Question 12

Clinical pearl: reassess patients for hypotension 30 - 60 minutes after administration of ____________.

Answer 12

antibiotics