Cv-Sepsis, Sepsis Syndrome, And Septic Shock

Front 1

Early indications for development of sepsis include:

Back 1

1. high temp
2. high HR
3. high respirations

Front 2

T or F: septic shock is #1 cause of mortality in the ICU.

Back 2

true

Front 3

What are some factors that predispose to sepsis and septic shock?

Back 3

1. alteration in host defenses
2. severe underlying illnesses
3. major surgery
4. presence of foreign bodies
5. obstructive process
6. treatment with cytotoxic or anti-metabolites
7. prior antibiotic therapy

Front 4

What is the chain of events that causes sepsis and septic shock?

Back 4

bacterial infection->bacteremia->inflammatory response->coagulation and decreased fibrinolysis->endothelial and vascular changes->hypoperfusion->organ failure

Front 5

What is the definition of SIRS? What are the s/s?

Back 5

1. systemic inflammatory response syndrome
2. 2 or more of the following: increased HR, temp, or respirations; changes in WBC count

Front 6

Is SIRS always caused by infection?

Back 6

no

Front 7

If SIRS is caused by infection, what is this?

Back 7

sepsis

Front 8

What is sepsis syndrome?

Back 8

sepsis + evidence of altered organ perfusion

Front 9

From best to worst, what is the order of sepsis?

Back 9

bacteremia->SIRS->sepsis->sepsis syndrome->septic shock->multiple organ dysfunction syndrome

Front 10

What is septic shock?

Back 10

septis syndrome + refractory hypotension

Front 11

What is multiple organ dysfunction syndrome?

Back 11

altered organ function in acutely ill patient such that homeostasis cannot be maintained without intervention

Front 12

What bacteria are present in sepsis via UTI? Deep wounds? Nosocomial infections?

Back 12

1. e. coli, klebsiella
2. anaerobes (clostridium)
3. staph spp.

Front 13

What are some common bacterial agents of sepsis?

Back 13

1. GNR
2. encapsulated pyrogens
3. staph spp.
4. beta-hemolytic strep
5. anaerobes

Front 14

What is morphology for pseudomonas?

Back 14

GNR, oxidase +, non-fermenting, opportunistic pathogen

Front 15

What bacteria has a high mortality rate in sepsis?

Back 15

pseudomonas

Front 16

What patients might suffer from pseudomonas infection?

Back 16

1. burns
2. immunocompromised
3. hot tubs
4. neutropenia
5. nosocomial

Front 17

Pseudomonas lesions in minority of patients are called what?

Back 17

ecthyma gangrenosum

Front 18

What are s/s of sepsis syndrome?

Back 18

1. apprehension
2. fever, chills (or hypothermia)
3. hyperventilation
4. hypotension
5. leukopenia or thrombocytopenia
6. altered organ function

Front 19

Sequence of hemological events in sepsis?

Back 19

capillary leakage and vasodilation->hypotension (becomes refractory to fluid replacement)->hypoperfusion->end organ damage

Front 20

What are the key steps in the host inflammatory response in sepsis?

Back 20

pattern recognition receptors on host cells detect foreign antigen->this causes activation of TNF, IL-1, and HMGB1->endothelium activates->increases secretion of coagulation products->coagulation increases and fibrinolysis decreases->end organ damage

Front 21

What is protein C? What is PAI-1?

Back 21

1. anticoagulant that inhibits PAI-1
2. PAI-1 decreases fibrinolysis

Front 22

T or F: septic patients are hyperglycemic.

Back 22

true

Front 23

What is one of the key treatments to stop septic shock from progressing?

Back 23

aggressive fluid replacement

Front 24

What organism would likely be found in a URI?

Back 24

strep pneumo