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29 Cards in this Set

  • Front
  • Back
Are bacteremia and sepsis the same thing?
No
What is bacteremia?
The presence of viable bacteria in the blood.
What is systemic inflammatory response syndrome (SIRS)?
the systemic inflammatory response to a variety of severe clinical insults.
What is the diagnostic criteria of SIRS?
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
SIRS can be caused by what?
Sepsis, hemorrhage, severe dehydration, heart failure, pericardial tamponade, pancreatitis, or trauma.
What is the definition of sepsis?
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
What is severe sepsis?
Sepsis associated with organ dysfunction, hypoperfusion, or hypotension.
Hypoperfusion and perfusion abnormalitites include lactic acidosis, oliguria, or an acute alteration in mental status.
What's the main difference between sepsis and severe sepsis?
The organ dysfunction in severe sepsis.
What is septic shock?
Sepsis with hypotension despite adequate fluid resuscitation, along with the presence of perfusion abnormalities.
What differentiates septic shock from severe sepsis and sepsis?
Hypotension despite adequate fluid resuscitation.
What is the definition of hypotension?
A systolic blood pressure of <90 mmHg or a reduction of >40 mmHg from baseline in the absence of other causes of hypotension.
What is the definition of multiple organ system failure?
The presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention.
Sepsis is intitiated by what?
by infection with bacteria or other microorganisms.
In sepsis, what causes the damage to normal tissue?
The endogenous inflammatory and coagulation mediators, (including leukocytes, macrophages, cytokines, thromboplastin and thrombin), are often nonspecific in their target, which causes tissue damage.
Why can't fluids cure sepsis?
Neutrophils cause damage to the endothelium, which leads to the release of nitros into the blood. This causes vasodilation.
Where are the most common sources of infection?
Kidney, liver or gallbladder, bowel, skin, and lungs.
What is often the first sign of sepsis?
Tachycardia
What are some common clinical presentations in a patient with sepsis?
Tachycardia, tachypnea, hyperthermia, and leukocytosis.
Can hospitalization be a predisposing factor of sepsis?
Yes
What are important parts of the PE?
Vital signs, alertness, catheters, HEENT, lungs, heart, abdomen, and skin.
What conditions can mimic sepsis?
Pancreatitis, trauma, severe hemorrhage, MI, drug overdose, and heat stroke.
What are important laboratory and radiographic evaluations?
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
Should a patient with sepsis be hospitalized?
Yes
What are indications for an ICU admission?
Hypotension and need for vasopressors
Marked metabolic abnormalities
Depressed sensorium
Oliguria/anuria
Sepsis concomitant with underlying cardiac or pulmonary disease
If a patient presents with sepsis, what would be your initial therapy?
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
When do you use corticosteriods in sepsis?
Only in severe sepsis with end organ damage.
When treating sepsis, would you wait until the blood cultures returned before starting antibiotics?
No, begin with broad spectrum directed against the suspected organism.
What is the most common cause of death in non-coronary ICUs in the US?
Sepsis Syndrome
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%.