30 Questions
Which of the following is a manifestation of sepsis?
Oliguria
What is the definition of septic shock?
Sepsis requiring pressors to maintain adequate organ perfusion
What is the most common cause of hospital admission?
Sepsis
Which patients are most at risk for hospital-acquired sepsis?
Patients with cancer, burns, trauma, or in the NICU
What induces pro-inflammatory cytokines in the sepsis pathogenesis?
Endotoxin or cell wall products
What happens to the bone marrow in response to sepsis?
Accelerates production of leukocytes
What effect does sepsis have on blood vessels?
Causes blood vessels to become leaky
What is a crucial test for sepsis diagnosis and monitoring?
Blood cultures (BCx)
Which patient factor puts individuals at higher risk for sepsis?
Immunosuppression
What does UA with reflex C&S aim to detect in sepsis?
Sepsis-related indicators
Which test is used to identify signs of infection or trauma in sepsis?
Urinary sediments examination
What may be needed if the sepsis diagnosis is not apparent?
GI labs and lumbar puncture
Which imaging technique is used to identify sources of infection in sepsis?
Abdominal CT
What are some manifestations of sepsis?
Renal dysfunction, AKI, coagulopathy
What are the criteria for Systemic Inflammatory Response Syndrome (SIRS)?
Heart rate, respiratory rate, temperature, and white blood cell count
What is used to assess organ failure risk in patients outside the ICU?
qSOFA score
Which stage of shock involves overwhelmed compensatory mechanisms and evident signs of organ dysfunction?
Shock
What are the distinct characteristics and symptoms of pre-shock?
Rapid compensation for diminished tissue perfusion and reversible effects of oxygen deprivation
What may patients in end-stage shock exhibit due to overwhelming infection?
Leukocytosis, leukopenia, and coagulopathy
What additional testing may be included for sepsis diagnosis?
Blood cultures, stool studies, and cerebrospinal fluid examination
What is the outcome of end-stage shock?
Irreversible organ damage and patient death
What is the most crucial predictor of mortality in sepsis?
Time to initiation of appropriate antimicrobial therapy
Which IV fluid is recommended for initial resuscitation in sepsis/septic shock?
0.9% NS or LR
What is the recommended antimicrobial therapy for sepsis?
Vancomycin with cephalosporin or beta-lactam/beta-lactamase inhibitor
Which pressor is used in distributive shock?
Levophed
What is essential for adequate gas exchange assessment in sepsis?
Supplemental oxygen, ABG test, intubation, and mechanical ventilation if necessary
What is a common consequence of inappropriate antibiotic selection in sepsis?
Markedly increased mortality
Which lab abnormality is often seen in sepsis and can lead to mental impairment?
Hypoglycemia
What is crucial for the diagnosis of sepsis?
Assessing recent travel, infectious contacts, and allergies/medication reactions
What should antimicrobial therapy consider in sepsis management?
Treating the most likely bugs, such as Gram positives, Gram negatives, and anaerobic infections
Study Notes
Sepsis Management and Empiric Antibiotic Therapy
- Lab abnormalities in sepsis often include hypoglycemia leading to mental impairment
- Diagnosis involves assessing recent travel, infectious contacts, and allergies/medication reactions
- Physical examination is crucial to localize the site of infection in the lungs, heart, abdomen, neuro, and skin
- Extensive studies including CBC, chemistries, blood, urine and sputum culture, wound cultures, and CSF exam are necessary for diagnosis
- Time to initiation of appropriate antimicrobial therapy is the strongest predictor of mortality in sepsis
- Inappropriate antibiotic selection is common and markedly increases mortality
- Antimicrobial therapy must consider the source of sepsis, treating the most likely bugs, such as Gram positives, Gram negatives, and anaerobic infections
- Empiric antibiotic therapy includes vancomycin with cephalosporin or beta-lactam/beta-lactamase inhibitor, or combinations if Pseudomonas is a consideration
- IV fluid resuscitation in sepsis/septic shock starts with 0.9% NS or LR at a dose of 30 mL/kg IV within the first three hours
- Pressors like Levophed and dobutamine are used in distributive and cardiogenic shock, respectively
- Hematologic treatment includes Packed RBCs, Fresh frozen plasma, and Platelets
- Adequate gas exchange assessment involves supplemental oxygen, ABG test, intubation, and mechanical ventilation if necessary
Test your knowledge of sepsis management and empiric antibiotic therapy with this quiz. Learn about lab abnormalities, diagnosis, physical examination, antimicrobial therapy, IV fluid resuscitation, pressors, and hematologic treatment for sepsis and septic shock.
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