Sepsis (7 questions)

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Author:
alvo2234
ID:
245800
Filename:
Sepsis (7 questions)
Updated:
2013-11-08 03:24:55
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Dr Swan
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Description:
PT III exam
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  1. most common causes of sepsis
    • UTI
    • pneumonia
  2. what is SIRS
    • temperature <= 36C or >=38.3
    • heart rate >=90
    • respiratory rate >= 20
    • WBC >= 12,000 or >=4,000
  3. what is the diagnostic criteria for sepsis
    • >= 2 SIRS criteria
    • infection
  4. what is the diagnostic criteria for severe sepsis
    sepsis + acute organ dysfunction
  5. what is the diagnostic criteria for septic shock
    severe sepsis + hypotension
  6. tools used to assess organ dysfuntion
    • SOFA
    • MODS
  7. when should initial resuscitation for severe sepsis begin
    within the first 6 hours
  8. what are the goals for resuscitation
    • CVP 8-12
    • MAP >=65
    • urine output >= 0.5
    • oxygen saturation >= 70
  9. how should initial mgmt diagnosis be performed
    • obtain cultures before antibiotics (<45 hrs)
    • obtain at least 2 blood cultures
    • perform imaging studies
    • use assays to help diagnose for candidiasis
  10. when should initial antibiotic therapy be administered
    within first hour of recognition of septic shock and severe sepsis
  11. how long should empiric therapy last
    3 - 5 days and then de-escalate the most appropriate single therapy
  12. how long is therapy for sepsis
    7 - 10 days
  13. when should an anatomic site of infection be established
    with 12 hours of presentation
  14. what device can be used for oropharyngeal decontamination
    chlorhexidine gluconate
  15. what are the sepsis campaign bundles to be completed within 3 hours
    • measure lactate levels
    • obtain blood cultures
    • administer broad spectrum antibiotics
    • administer crystalloid for hypotension
  16. what are the sepsis bundles to be completed within 6 hours
    • vasopressors to maintain MAP >=65
    • measure venous pressure and oxygen
    • remeasure lactate if elevated
  17. what should and shouldnt be used for fluid therapy
    crystalloids should and hydroxyethyl starches shouldnt because they can cause kidney damage
  18. what is the initial fluid challenge target
    at least 30 ml/kg or crystalloid
  19. at what rate should fluid challenges be given
    1000ml of crystalloids or 300-500 colloids over 30 minutes
  20. what type of colloid is the major choice in the US
    albumin
  21. what should be inserted into patients requiring vasopressors
    arterial catheter
  22. what is the initial vasopressor that should be used
    NE
  23. when can vasopressin be added to vasopressor therapy
    to decrease the NE dose
  24. what can be added to pts with refractory shock
    can add or substitute epinephrine
  25. when can dopamine be used in vasopressor therapy
    as alternative therapy for pts at low risk or arrhythmia and bradycardia
  26. which drug can be used in inotropic therapy and when can it be used
    dobutamine in pts with myocardial dysfunction supported by elevated cardiac filling pressures adn low cardiac output
  27. when should corticosteroids not be used
    in the absence of shock

    septic shock pts if hemodynamics are resotred with fluids and vasopressors
  28. when should steroids be used in septic pts
    in refractory shock, consider IV hydrocortisone 200mg/day

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