Fever, Bacteremia, Sepsis

Front 1

Definition of fever

Back 1

Adults: oral temp above 37 C
Infants & toddlers: rectal temp of 38 C+

Front 2

The thermoregulatory center is the __.

Back 2

hypothalamus

Front 3

Euthermia

Back 3

temperature is maintained near normal by either physiological mechanisms or chemical mechanisms

Front 4

Sweating and hyperventilation ___ temperature.

Back 4

decrease

Front 5

vasoconstriction and shivering ___ temperature.

Back 5

increase

Front 6

Chemical mechanisms of body temp control include (3)

Back 6

interleukins
prostaglandins
prostacyclins

Front 7

Fever may be good for your health upon infection - why?? (5 reasons)

Back 7

- increase release of luekocytes
- enhances inflammatory response
- slows down bacterial proliferation
- enhances phagocytic killing by leukocytes
- increases bacterial requirement for iron, while decreasing host absorption of iron

Front 8

T/F: It is better to take drugs to lower temperature right away.

Back 8

False. It may be better to wait to take drugs to allow the body to fight the infection.

Front 9

Defintion of bacteremia

Back 9

presence of bacteria in blood

Front 10

Transient bacteremia happens every day while ____.

Back 10

brushing teeth

Front 11

Continuous bacteremia can be caused by ___.

Back 11

indwelling IV or arterial catheters

Front 12

3 responses of the body to bacteria in the bloodstream

Back 12

1) activation of the coagulation cascasde--> crucial for repair
2) cytokines released --> increase neutrophils
3) activation of complement

Front 13

systemic coagulation activation

Back 13

small clots everywhere --> thrombi + DIC- factors are consumed --> will not work they need to --> hemorrhage. This is PARADOXICAL- have active clotting but also have hemorrhages.

Front 14

Systemic cytokine release + complement activation

Back 14

neutrophils damage blood vessels directly + they leave blood and go into tissue due to vasodilation --> decrease bp --> organ damage

Front 15

SIRS= systemic inflammtory response syndrome criteria

Back 15

1) temp >38 or <36
2) HR > 90 beats/min
3) respiration > 20/min or PaCO2 <32 mmHg
4) WBC count > 12,000/mm3, < 4,000/mm3 or > 10% immature (band) cells
Need TWO or more criteria

Front 16

Sepsis

Back 16

SIRS + documented infection
Blood cultures do NOT need to be +

Front 17

Severe sepsis is associated with ___ (2)

Back 17

organ dysfunction
hypotensioon

Front 18

T/F: The problem in sepsis the the bacteria

Back 18

False. The problem is the immune system recognizing bacteria in a systemic way

Front 19

Septic shock definition

Back 19

Sepsis-induced hypotension despite fluid administration.

Front 20

T/F: Septic shock is the most common cause of mortality in the ICU.

Back 20

True

Front 21

Mortality rate despite treatments:
___% of patients with sepsis.
___% of patients with septic shick

Back 21

16
40-60

Front 22

Gram + etiology (4)

Back 22

Staph. aureus --> TSS
Strept. pneumoniae
Strept. pyogenes
Enterococcus species

Front 23

____ is the most common cause of anaerobic septicemias.

Back 23

Bacteroides fragilis

Front 24

___ (2) is the leading cause of neonatal sepsis.

Back 24

E. coli & S. agalactiae

Front 25

Increased mortality is associated with ___ (3)

Back 25

Pseudomonas aeruginosa, Candida albicans, multidrug resistant Enterococcus faecium.

Front 26

Factors contributing to increasing incidence of sepsis

Back 26

1) chemotherapy & radiation therapy
2) corticosteroid & immunosuppressive therapy
3) longer lives --> elderly, diabetics, cancer, major organ failure
4) neonates
5) invasive devicesw --> surgical protheses, inhalation equipment, and IV & urinary catheters

Front 27

non- specific signs & symptoms

Back 27

fever, chills, fatigue, malaise, anxiety, or confusion --> not pathognomonic and may be absent in serious infections esp. in the elderly

Front 28

MODS= multiple organ dysfunction syndrome

Back 28

presence of altered organ function in the acutely ill

Front 29

Complications associated with sepsis

Back 29

adult respiratory distress syndrome
DIC
acute renal failure
intestinal bleeding
liver failure
CNS dynfunction
heart failure
death

Front 30

Diagnosis

Back 30

history
physical exam
appropriate lab tests
close follow-up of hemodynamic status

Front 31

Therapy

Back 31

- Immeidiate stabilization of the patient
- Reversal of life-threatening abnormalities--> Airway, breathing, circulation
- severe sepsis --> ICU --> moniter vital signs, maintain CO and ventilation with drugs, dialysis to assist kidneys, mainatin arterial bp in hypotensive patenus with vasoactive drugs (dopamine, dobutamine or NE)
- broad spectrum antobiotics 1st until ID the organisms

Front 32

The original focus of infectopm must be treated by ___ or ____.

Back 32

removing foreign bodies
removing infected organs --> debride or amputate gangrenous tissue

Front 33

T/F: once a patient has sepsis it is good for them to have fever.

Back 33

False! Once there is sepsis we do NOT want fever because it potentiate the immune system and make the situation worse.