Sepsis

Question 1

What is one of the first steps in the progression of sepsis?

Answer 1

Endothelial injury

This leads to (1) widespread coagulation and (2) inflammation.

Question 2

How common is sepsis?

Answer 2

• The incidence doubled from 2000 to 2008.

* Accounts for about 9.3% of deaths in the U.S.

Question 3

The mortality of sepsis is about _______________.

Answer 3

25% for young people and 50% for the elderly

Question 4

What drives sepsis?

Answer 4

The body’s immune response

In fact, it is better to characterize the bacteria that cause sepsis as bystanders because the body essentially kills everything in response to LPS.

Question 5

How can the hyperimmune response be treated?

Answer 5

With steroids

For instance, a young person with meningitis might be given steroids to prevent the “inflammatory shambles.”

Question 6

In about 1/3 of the cases of sepsis, ___________ is found.

Answer 6

no organism

This suggests that endogenous release of damage signals can cause sepsis.

Question 7

What seven conditions can mimic sepsis?

Answer 7

• Acute myocardial infarction
• Acute pulmonary embolism
• Ablaze (burn injuries)
• Acute pancreatitis
• Acute drug reactions
• Acute pancreatitis
• Accidents (major trauma)

(“Doing My Best To Prevent Grave Prognoses” = drugs, MI, burns, trauma, pancreatitis, GI bleeds, PE.)

Question 8

SIRS has been replaced in Feb. 2016 with ___________.

Answer 8

sepsis 3.0

Question 9

Recently, researchers have discovered that _________________ is the best predictor of sepsis outcome.

Answer 9

changes in mental status

Question 10

One of the best ways to decrease mortality in sepsis is _______________.

Answer 10

to give antibiotics in the first hour after onset of hypotension

Question 11

What are the SIRS criteria?

Answer 11

• Temp: greater than 38º C or less than 36ºC
• HR: greater than 90
• RR: greater than 20
• PaCO2: less than 32 mm Hg

Question 12

What feature needs to be added to the SIRS criteria to be considered shock?

Answer 12

BP less than 90 despite fluid resuscitation

Question 13

What are the organ dysfunction variables?

Answer 13

• PaO2:FiO2 less than 300
• Creatinine 0.5 mg/dL higher than baseline
• Thrombocytopenia
• Total bilirubin greater than 4 mg/dL

Question 14

Microcoagulation begins to occur due to ______________.

Answer 14

the overexpression of tissue factor

Question 15

In culture-positive cases, most often the organism is ________________.

Answer 15

Gram-negative

Question 16

The most common site of infection in sepsis cases is _______________, while the site with the highest mortality is ______________.

Answer 16

the lungs; the blood

Question 17

Current studies are looking at ways to _____________ in early sepsis and ____________ in late sepsis.

Answer 17

down-regulate the immune system; up-regulate the immune system

Question 18

The sepsis bundle advises what treatment components?

Answer 18

• Abx in first hour
• Fluid resuscitation in first hour (30 ml/kg)
• Cultures (blood and respiratory)
• Routine screening for suspected sepsis
• Vasopressors
• Normalize serum lactate

Question 19

What are the guidelines for antibiotic treatment in sepsis?

Answer 19

• Always cover for MRSA until bacteria is known

* Double cover for resistant Gram-negative bacteria

Question 20

______________ clearance has been shown to correlate with greatly reduced sepsis mortality.

Answer 20

Lactate