Teaching Points 5.16.14

Question 1

SIRS criteria

Answer 1

Systemic Inflammatory Response Syndrome. Criteria = 2+ of the following:

1. Fever > 38
2. HR > 90
3. RR > 20 – or – PaCO2 < 32 mmHg
4. WBC > 12,000 – or – WBC < 4,000

Question 2

BISAP criteria

Answer 2

Bedside Index of Severity in Acute Pancreatitis

• BUN
• Impaired mental status
• SIRS
• Age
• Pulmonary embolism

Question 3

What are Rhonchi?

Answer 3

Rhonchi are sounds that resemble snoring. They occur when air is blocked or becomes rough through the large airway

Question 4

What are Rales?

Answer 4

Rales are small clicking, bubbling, or rattling sounds in the lungs. They are believed to occur when air opens closed air spaces. Rales can be further described as moist, dry, fine, and course.

Question 5

What are Wheezes?

Answer 5

Wheezes are high-pitched sounds produced by narrowed airways when a person EXHALES. Wheezing and other abnormal sounds can sometimes be heard without a stethoscope.

Question 6

What is Stridor?

Answer 6

Stridor is a wheeze-like sound heard when a person INHALES. Usually it is due to a blockage of airflow in the windpipe (trachea) or in the back of the throat.

Question 7

Sepsis Criteria

Answer 7

SIRS + Source of infection

Question 8

Severe Sepsis Criteria

Answer 8

Organ Dysfunction, Hypotension, or Hypoperfusion:

• Lactic Acidosis
• SBP <90
  or
• SBP Drop ≥ 40 mmHg from normal

Question 9

Septic Shock Criteria

Answer 9

Severe Sepsis with Hypotension, despite adequate fluid resuscitation

Question 10

Multiple Organ Dysfunction Syndrome Criteria

Answer 10

Evidence of ≥ 2 Organs Failing

Question 11

2 definitions of “left shift” (according to Sushma)

Answer 11

1. Bandemia
   (increased bands & neutrophils = infection — increased bands alone = leukemia)
2. Toxic granulation
   (commonly found in patients w/ sepsis)

Question 12

Respiratory Exam: Observation of patient

Answer 12

• Distressed breathing? Diaphoretic/labored?
• Use of accessory muscles? (scalenes, sternocleidomastoids, etc.)
• Color of lips & nail beds (blue = bad)
• Position (“tripod” = leaning forward w/ hands on knees)
• Breathing through pursed lips = emphysema
• Ability to speak (how many words?)
• Audible noises to naked ear (wheezing or gurgling?)
• Abdominal wall movement (paradoxical breathing = ab wall moves in during inhalation b/c of flat diaphragm)
• Chest or spine deformities (Pectus Excavatum, Barrel chest, Kyphosis, Scoliosis)

Question 13

Normal Tactile Fremitus finding?

Answer 13

Vibration felt by the ulnar aspect of the hands on the patient’s back (posture thorax)

Question 14

Tactile Fremitus finding in Consolidation?

Answer 14

Fremitus becomes more pronounced

Question 15

Tactile Fremitus finding in Pleural Effusion?

Answer 15

Fremitus (vibration) decreases

fluid collects & bottom & displaces lungs upwards