Sepsis and Septic Shock

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How is SIRS defined?

2 or more of the following: Temp >38 (100.4) or < 36 (96.8) HR >90 RR > 20 or PaCO2 <32 WBC > 12,000 or <4000 or >10% bands

How long should patients be treated with antibiotics?

7-10 days (should D/C if non-infectious)

What is the goal for CVP?

8-12 mmHg

what is the BG goal in patients with shock?

<180

what is the goal for UOP?

>0.5 ml/kg/hr

Above what dose of corticosteroids can be harmful?

>300mg

What is the hallmark sign of sepsis?

Hypotension

What are common empiric antibiotic choices?

IV B-lactamase inhibitor combos (Unasyn, Zosyn) Carbapenem 4th generation cephalosporin (cefepime)

Where is the most common source of infection?

Lungs

As the dose of vasopressors increases, what types of side effects increase?

Side effects caused by alpha effects

When is dobutamine used?

in low CO

What is a significant side effect of corticosteroids in sepsis?

secondary infections

Can D5W be used in shock?

NO! can increase edema

What is the Vasopressor DOC?

Norepinephrine

What is an example of a crystalloid fluid?

Normal saline (0.9%)

How should NS be given?

1L over 30 minutes (minimum of 30ml/kg in the first 4-6hrs)

What is used to treat MRSA?

Vancomycin

What are alternative vasopressors?

Vasopressin, Epinephrine, dopamine, dobutamine

How is severe sepsis defined?

sepsis associated with organ dysfunction, hypoperfusion and hypotension

What is the dose of norepinephrine that should be used?

0.1-0.5 mcg/kg/min

When is dopamine not used?

As a renal protective agent (low dose)

When should vancomycin be added to regimens?

If MRSA is prevalent based on resistance patterns

Can epinephrine be used initially?

NO! can be used as add on therapy

which antibiotics can be used for gram negative infections?

Pip/tazo cefepime/ceftazadime imipenem/meropenem (good if penicillin allergy) Ciprofloxacin/Levofloxacin Aminoglycosides

How is sepsis defined?

SIRS + documented infection

True or false: There is currently no cure for sepsis

True (all care is supportive)

When should BG be treated and what agent should be used?

When the patient is stabilized use IV insulin infusion 0.1 unit/kg/hr

When are corticosteroids used in shock?

after fluid and vasopressors if BP is still non-responsive (severe refractory hypotension)

Why is dobutamine preferred over dopamine in low CO?

it only has Beta effects while dopamine has both beta and alpha 1 effects

What does a high lactate level indicate?

lack of tissue O2 and anaerobic metabolism

What is a side effect of prolonged vasopressor administration?

significant peripheral tissue ischemia (gangrene in fingers and toes)

What other treatments should sepsis patients undergo?

stress ulcer and DVT prophylaxis, respiratory and renal support, protocol driven sedation/analgesia monitoring, BG control

what are signs and symptoms of early sepsis?

fever, chills, tachycardia, tachypnea, hyperglycemia, altered mental status, oliguria, hypotension, low CV O2 saturation

When is dopamine reserved for?

low CO

what is the average amount of fluid needed?

4-6L

What is an example of a colloid fluid?

5% albumin solution

What is the goal for MAP?

>65 mmHg

What are the important points about antibiotic therapy?

It should be prompt (within 1 hour)! it should start broad (empiric), should assess and de-escalate daily if possible

What are the signs and symptoms of late sepsis?

Lactic acidosis, pulmonary edema, myocardial depression, hypoglycemia, thrombocytopenia, DIC, coma

How is septic shock defined?

Sepsis induced hypotension, despite fluid resuscitation (requires vasopressors, MAP <65)

How do you calculate MAP?

[(2 x DBP) + SBP] / 3


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