MEDICATIONS
THE FIRST LINE ANTIBIOTICS USED FOR SEPSIS
WHAT ARE VANCO AND ZOSYN?
TOGETHER, THEY ARE THE MOST BROAD YOU CAN GET. ZOSYN INCLUDES PSEUDOMONAL COVERAGE WHILE VANCO CONTAINS MRSA COVERAGE.
I WILL REDRAW THE LACTATE WITHIN:
WHAT IS 6 HOURS?
MOST PROVIDERS WOULD WANT A REPEAT AFTER FLUIDS, AS LONG AS IT IS WITHIN 6 HOURS WITH IMPROVEMENT!
80 YEAR OLD MALE COMING FROM THEIR NURSING HOME WITH A BASELINE OF DEMENTIA. PT APPEARS TO BE CONFUSED, WITH A TEMP OF 100.7F AND TACHY AT 112. PT WITH CHRONIC FOLEY, LAST CHANGED ABOUT A MONTH AGO. IS PT SUSPECTED TO BE SEPTIC?
WHAT IS NO?
PT MOST LIKELY HAS A UTI. A SEPTIC WORKUP WILL POSSIBLY BE ORDERED IF THEIR URINE COMES BACK CLEAN.
HR ABOVE:
WHAT IS 100?
WE RUN FOR THIS PRESSOR WHEN THE PATIENTS PRESSURE STARTS DROPPING
WHAT IS LEVOPHED (NOREPINEPHRINE)?
LEVO CONTRACTS THE HEART WHILE PROMOTING CIRCULATION BY CONSTRICTING PERIPHERALLY.
I SHOULD BE CONCERNED OF A LACTATE OF:
WHAT IS GREATER THAN 2?
37 YEAR OLD FEMALE SENT FROM MORRIS CANCER CENTER PRESENTS NON-FEBRILE BUT TACHY AT 128. PT STATES THEY HAVE BEEN TREATED FOR PNA AND HAD A TEMP OF 100.9F AT HOME BUT TOOK TYLENOL PRIOR TO ARRIVAL. LAST CHEMO WAS 2 DAYS AGO, PORT REMAINS ACCESSED. ARE THEY SEPTIC?
WHAT IS YES?
ONCOLOGY PATIENTS ON TREATMENT ARE AT HIGH RISK FOR INFECTION LEADING TO SEPSIS. PATIENTS WITH ACCESSED PORTS ARE ALSO AT RISK FOR CLABSI'S.
MAP LESS THAN:
OH NO! I'M BURNING UP. PLEASE GO GRAB THIS ANTIPYRETIC
WHAT IS OFIRMEV?
IV OVER PO FOR A QUICKER ONSET.
WHAT TWO LAB VALUES CAN BE CONSIDERED IN THE SEPTIC PARAMETERS?
WHAT ARE LACTATE AND WBC?
TRAUMA BRAVO! MALE PATIENT SUSTAINED AN OPEN TIB-FIB. VITALS AT THE MOMENT INCLUDE A BP OF 80/40, HR OF 122, RESPIRATIONS OF 25, AND A TEMP OF 100.4F. DO YOU PRIORITIZE ANTIBIOTICS OR RADIOLOGY?
WHAT ARE ANTIBIOTICS?
WE HAVE AN HOUR WHEN THE PROVIDER SUSPECTS SEPSIS TO GET THE LABS AND MEDS IN, THIS IS A PRIORITY OVER RADIOLOGY.
TEMP OVER:
OR UNDER:
WHAT IS 100.4F OR 96.8F?
THE DOCTOR ORDERS 2000 ML ON A SEPTIC PATIENT WITH A HISTORY OF HTN, CHF, & DM. I SHOULD:
WHAT IS QUESTION THE DOCTOR?
DO NOT OVERLOAD! OPT TO START PRESSORS FOR SUSTAINED HYPOTENSION.
THE PROVIDER ORDERS FLUIDS, MRSA SWAB, ANTIBIOTICS, AND BLOOD CULTURES. I WILL MAKE SURE OF WHAT?
WHAT IS BLOOD CULTURES BEFORE ANTIBIOTICS?
40 YEAR OLD MALE BROUGHT IN BY HIS WIFE FOR INCREASED CONFUSION AND A HIGH FEVER AT HOME. PER WIFE, PT HAS BEEN HAVING A COUGH AND FEVER FOR THE PAST 3 DAYS. VITALS INCLUDE A HR OF 145, BP OF 85/40, TEMP OF 102F, AND 88% ON RA. WHAT IS THE INTIAL DIAGNOSIS?
WHAT IS SEPTIC SHOCK?
THIS PT IS IN SEPTIC SHOCK AS NOTED BY THE CONFUSION (IMPAIRED OXYGEN DELIVERY AND TISSUE PERFUSION). ORGAN FAILURE INDICATES SHOCK.
RESPIRATIONS ABOVE:
WHAT IS 20?
IN THE RESUS BAY, THE DOCTOR ORDERS ROCEPHIN AND VANCO. I SHOULD:
WHAT IS QUESTION THE DOCTOR?
ROCEPHIN LACKS PSUEDOMONAL COVERAGE, OPT FOR ZOSYN.
I AM THE MOST FORGOTTEN LAB TO BE CONSIDERED DURING SEPSIS
WHAT IS BILIRUBIN?
BILIRUBIN CAN BE ELEVATED AS LIVER DAMAGE OCCURS, MORE COMMON IN CASES OF SEVERE SEPSIS.
40 YEAR OLD MALE WITH HISTORY OF ALCOHOL ABUSE COMES IN WITH EPIGASTRIC PAIN ASSOCIATED WITH NAUSEA AND VOMITING X3 DAYS. WIFE BRINGS PATIENT IN DUE TO INCREASED CONFUSION. VITALS SHOW A HR OF 140, BP OF 83/49, TEMP 100.5F, RESPIRATIONS AT 26, AND 96% ON RA. IS HE SEPTIC?
WHAT IS NO?
ACUTE PANCREATITIS IS A CLOSE MIMIC TO SEPSIS. USE PATIENTS HISTORY AND PRESENTATION AS A WAY TO ASSUME CARE.
PATIENT COMES IN TACHY IN THE 130'S, EKG WITHIN NORMAL LIMITS. THEY ARE NOW REQUIRING 4L O2 IN TRIAGE. WHAT ORDERS WILL YOU SUSPECT?
WHAT IS SEPTIC WORKUP?
ANY PATIENT WITH TWO OR MORE OF THE VITAL SIGN PARAMETERS REQUIRE A SEPTIC WORKUP HOWEVER A NEW REQUIREMENT OF O2 COUNTS FOR ONE OF THE PARAMETERS AS WELL.