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29 Cards in this Set
- Front
- Back
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Are bacteremia and sepsis the same thing?
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No
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What is bacteremia?
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The presence of viable bacteria in the blood.
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What is systemic inflammatory response syndrome (SIRS)?
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the systemic inflammatory response to a variety of severe clinical insults.
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What is the diagnostic criteria of SIRS?
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Two or more of the following:
Temperature: > 38 C or < 36 C HR: > 90 bpm RR: >20 WBC: > 12,000 cells/mm3, < 4000 cells/mm3, or > 10% immature band forms |
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SIRS can be caused by what?
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Sepsis, hemorrhage, severe dehydration, heart failure, pericardial tamponade, pancreatitis, or trauma.
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What is the definition of sepsis?
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The systemic response to infection, manifested by two or more of the following:
Temperature: > 38 C or < 36 C HR: > 90 bpm RR: >20 WBC: > 12,000 cells/mm3, < 4000 cells/mm3, or > 10% immature band forms |
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What is severe sepsis?
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Sepsis associated with organ dysfunction, hypoperfusion, or hypotension.
Hypoperfusion and perfusion abnormalitites include lactic acidosis, oliguria, or an acute alteration in mental status. |
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What's the main difference between sepsis and severe sepsis?
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The organ dysfunction in severe sepsis.
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What is septic shock?
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Sepsis with hypotension despite adequate fluid resuscitation, along with the presence of perfusion abnormalities.
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What differentiates septic shock from severe sepsis and sepsis?
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Hypotension despite adequate fluid resuscitation.
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What is the definition of hypotension?
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A systolic blood pressure of <90 mmHg or a reduction of >40 mmHg from baseline in the absence of other causes of hypotension.
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What is the definition of multiple organ system failure?
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The presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention.
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Sepsis is intitiated by what?
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by infection with bacteria or other microorganisms.
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In sepsis, what causes the damage to normal tissue?
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The endogenous inflammatory and coagulation mediators, (including leukocytes, macrophages, cytokines, thromboplastin and thrombin), are often nonspecific in their target, which causes tissue damage.
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Why can't fluids cure sepsis?
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Neutrophils cause damage to the endothelium, which leads to the release of nitros into the blood. This causes vasodilation.
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Where are the most common sources of infection?
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Kidney, liver or gallbladder, bowel, skin, and lungs.
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What is often the first sign of sepsis?
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Tachycardia
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What are some common clinical presentations in a patient with sepsis?
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Tachycardia, tachypnea, hyperthermia, and leukocytosis.
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Can hospitalization be a predisposing factor of sepsis?
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Yes
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What are important parts of the PE?
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Vital signs, alertness, catheters, HEENT, lungs, heart, abdomen, and skin.
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What conditions can mimic sepsis?
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Pancreatitis, trauma, severe hemorrhage, MI, drug overdose, and heat stroke.
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What are important laboratory and radiographic evaluations?
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CBC (looking for bandemia and thrombocytopenia)
BMP (glucose rises in severe infection) LFTs (increase in severe sepsis) PT/PTT (increase in severe sepsis) two sets of blood cultures pulse ox CXR (upright) UA and culture |
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Should a patient with sepsis be hospitalized?
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Yes
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What are indications for an ICU admission?
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Hypotension and need for vasopressors
Marked metabolic abnormalities Depressed sensorium Oliguria/anuria Sepsis concomitant with underlying cardiac or pulmonary disease |
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If a patient presents with sepsis, what would be your initial therapy?
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ABC's
IV fluids with crystalloid (wide open) Type and Crossmatching and PRBCs pending cause Immediate antibiotic therapy Vasopressors Tight regulation of glucose Acidosis correction Surgery, if necessary |
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When do you use corticosteriods in sepsis?
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Only in severe sepsis with end organ damage.
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When treating sepsis, would you wait until the blood cultures returned before starting antibiotics?
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No, begin with broad spectrum directed against the suspected organism.
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What is the most common cause of death in non-coronary ICUs in the US?
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Sepsis Syndrome
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True or False:
With treatment, sepsis syndrome is cured nearly 100% of the time. |
False: despite treatment, the mortality rate of sepsis syndrome is about 30%.
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