Septicemia

Question 1

SIRS definition

Answer 1

The presence of 2 or more of the following:

Temp: >38.5 or 90 bpm
RR: >20 breaths/min
PaCO2 <32
WBC: 12 000 or 10% bands

Question 2

Sepsis definition

Answer 2

SIRS+ known infection

Question 3

Severe sepsis

Answer 3

SIRS+ known infection + organ dysfunction

Question 4

Septic shock

Answer 4

SIRS+ known infection+ organ dysfunction+ hypotension despite adequate fluids (require vasopressor support)

Question 5

Refractory septic shock

Answer 5

Septic shock + lots of dopamine/epi/NE

Question 6

Sepsis

-epidemiology (incidence of sepsis in last century and who is likely to get it)

Answer 6

-incidence of sepsis has gone up because all of the following list has gone up, and resistance has too.

At risk:

• invasive medical devices (e.g. intravascular catheters)
• immunosuppressed cancer and transplant patients
• Diabetes

Question 7

Sepsis

• clinical presentation
• what to look for on the physical

Answer 7

Usually non-specific:

• fever
• chills
• fatigue, malaise, anxiety, confusion

What to look for:

• focal symptoms that may tell you where the infection started
• neck stiffness (as in meningitis)
• purpura fulminans (sign of DIC)

Question 8

Sepsis

-what tests to order

Answer 8

• blood/urine/sputum/tissue cultures +Gram stain
• CBC with differential
• Serum electrolytes, glucose
• Renal function (creatinine, BUN)
• Liver function (AAT, ALT, bilirubin)
• Lactate (tells you if hypoperfusion exists)
• Arterial blood gases
• Prothrombin time (DIC?)
• CXR if suspected pulmonary
• US if suspected biliary
• CT if suspected intraabdominal

Question 9

Sepsis

-management

Answer 9

• Must achieve control of the infection source
• Start broad spectrum empiric therapy as soon as the cultures are drawn. Therapy is based on the suspected source of infection.
• v. important to start broad-spectrum therapy ASAP**
• Hemodynamic support (IV fluids, vasopressors

Question 10

When to do a blood culture

Answer 10

• endocarditis
• pyelonephritis
• pneumonia
• meningitis
• pyogenic (septic) arthritis
• osteomyelitis
• PID
• cellulitis
• ill children and ill elderly with serious nondescript S/S

Question 11

Common causes of immunocompromise

Answer 11

• Genetic
• Acquired (HIV, some cancers)
• Chronic (DM, cirrhosis)
• Medications (steroid, chemotherapy, radiation, transplant meds)
• Pregnancy

Question 12

Possible affected immune system components

Answer 12

Damaged integuement
Impaired cellular immunity
Impaired humoral immunity
Asplenia
Complement deficiency
Neutropenia

each deficiency will have a different set of pathogens

Question 13

Febrile neutropenia

• definition
• epidemiology (who gets it)
• management

Answer 13

• Fever and ANC < 500 (normal 2500-6000)
• Often cancer patients undergoing chemotherapy get this
• Start empiric Ab right away: Pip-tazo if no focus of infection is known
• So many flow charts….