thera sepsis

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Author:
coal
ID:
259869
Filename:
thera sepsis
Updated:
2014-02-16 15:27:26
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thera sepsis
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thera sepsis
Description:
thera sepsis
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  1. SIRS definition
    • temp > 38 or < 36
    • WBC >12000 or < 4000 or > 10% bands
    • HR > 90 bpm
    • RR > 20
  2. sepsis definition
    presence (probable or documented) of infection + systemic manifestations of infection
  3. severe sepsis definition
    sepsis + sepsis-induced organ dysfunction or tissue hypoperfusion
  4. septic shock definition
    sepsis-induced hypotension persisting despite adequate fluid resuscitation
  5. MAP formula
    ((2x diastolic BP) + systolic BP))/3
  6. 2 biomarkers in sepsis
    lactate = inadequate perfusion, body undergoing anaerobic metabolism

    procalcitonin = immune response to presence of bacteria, no affected by steroids so specific to infection
  7. agents to consider for MRSA
    • vancomycin
    • linezolid
    • daptomycin
  8. agents to consider for pseudomonas aeruginosa
    • cefepime
    • doripenem
    • meropenem
    • piperacillin
    • tobramycin
    • tazobactam
  9. agents to use for ESBL, enterococcus
    • doripenem
    • meripenem
  10. agent to use for vancomycin resistant enterococcus
    daptomycin
  11. agent to use for candida albicans
    fluconazole or caspofungin/micafungin
  12. agent to use for influenza
    • oseltamavir
    • zanamavir
  13. what 3 things is CVP indicating
    • right atrial pressure
    • reflects amt of blood returning to heart
    • ability of heart to pump blood into arterial system
  14. what does MAP represent
    • average arterial pressure over 1 cardiac cycle
    • [(2X diastolic BP) + systolic BP]/3
  15. 5 situations when extended duration of therapy should be used
    • 1. slow clinical response
    • 2. undrainable source of infection
    • 3. bacteremia with S. aureus
    • 4. fungi or viral infections
    • 5. immunosuppressed pts
  16. 5 early goal-directed therapy: initial 6 hours
    • CVP 8-12 mmHg
    • MAP > 65 mmHg
    • urine output > 0.5 mL/kg/hr
    • Scv O2 > 70%
    • normalize lactate if elevated
  17. 5 procedures for early goal directed therapy
    • cultures if obtained w/o delay of antimicrobial therapy (>45mins)
    • at least 2 sets of blood cultures
    •   aerobic & anaerobic bottles
    •   1 drawn percutaneously, 1 vascular device
    • use 1,3 beta-D-glucan assay if candidiasis
    • rapid influenza antigen if flu season
    • imaging to confirm source of infection
  18. 4 early targeted therapy to be completed wi 3 hrs
    • 1. measure lactate level
    • 2. obtain blood cultures prior to antibiotics
    • 3. administer broad spectrum antibiotics
    • 4. admin 30 mL/kg of crystalloid for HoTN or lactat > 4 mmol/L
  19. sepsis bundle to be completed w/I 6 hours (3)
    • apply vasopressors (if HoTN) does not respond to initial fluid resuscitation to maintain MAP of > 65mmHg
    • if septic shock or initial lactate > 4 mmol/L measure CVP and ScvO2
    • measure lactate a second time if initial lactate was elevated
  20. first line in septic shock
    norepinephrine
  21. what pt population should dopamine be used in to treat septic shock
    • low risk tachyarrythmia
    • bradycardia
  22. if treating septic shock with norepinephrine and you need an additional agent what would you choose
    • vasopressin - raise MAP and decrease NE use
    • epinephrine - 3rd line agent
  23. when would you add dobutamine to a vasopressor in treatment of septic shock
    • myocardial dysfunction w/low cardiac output
    • ongoing signs of hypoperfusion despite adequate volume replacement and MAP
  24. what are the most common choices for fluid replacement and the rate
    • 0.9% sodium chloride or lactated ringers
    • 30 mL/kg
  25. what would you pick if your pt has tried adequate fluid resuscitation and vasopressor therapy without results and they are hemodynamically unstable
    • hydrocortisone 50mg IV q6h
    • only to be used in septic shock
  26. 8 indications for stress ulcer prophylaxis
    • ICU plus one of the following
    • coagulopathy (platelets <50,000 or INR 1.5)
    • mechanical ventilation > 48 hrs
    • Glasgow coma score < 10
    • burns >35% BSA
    • multiple trauma
    • recent transplant
    • spinal cord injury
    • hepatic failure

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