Definitions and Dx
Bugs
Drugs (Abx)
Non-Abx Management
Wildcard
100
What are the two scoring systems used to diagnose sepsis
1. SIRS + suspected infection
2. qSOFA
100
What are the three microorganisms you would be concerned for in an 11 week old presenting with fever and nuchal rigidity?
E. Coli
Group B Strep
Listeria
100
Name the 2 antibiotics you would start on a neonate presenting with a fever.
Ampicillin + Cefotaxime or Gentamicin
100
What do the following septic patients have in common?
- pt with a tunneled HD cath; pt with a missed abortion; pt with ascending cholangitis; pt with nec fasc
They need source control!
Call a surgeon!
100
What document details the recommendations for the treatment of sepsis?
"Surviving sepsis campaign" documents, updated frequently
200
the qSOFA score (name 2)
hypotension (sBP<100)
AMS
RR >22
OR increase in SOFA score by 2 points
200
This patient is diabetic. What diagnosis is most likely.
Mucormycosis
200
You are called into a room to care for a 20yo febrile, seizing patient. Skin exam shows a diffuse petechial/purpuric rash. What is your antibiotic of choice?
Ceftriaxone to treat meningococcemia
200
What are your first and second-line vasopressors in septic shock?
1. Norepinephrine (levophed)
2. Vasopressin
200
What is a pulmonary complication that can result from sepsis-associated inflammation?
ARDS
300
The SIRS criteria (name 2)
***bonus if you name all 4
HR>90
RR >20
Temp >38C
WBC >12K
300
Epistaxis patient w/ no PMH who had rhino rocket placed 5d ago now presenting with fever, diffuse rash, and hypotensive. Most likely diagnosis?
Toxic Shock Syndrome (SA or GAS)
300
What is your antibiotic of choice for a septic patient with a known history of IV drug use?
Vancomycin for staph aureus coverage
300
Dr. Haycock returns from ultrasounding your patient in septic shock and says, "This patient has a component of heart failure and their cardiac output is low". What vasopressor/inotrope should you consider?
Epinephrine
300
What is the end point of the imbalance in procoagulant and anticoagulant functioning associated with sepsis?
***bonus points for the labs we need to diagnose this
disseminated intravascular coagulation
***labs: thrombocytopenia, decreased fibrinogen levels, elevated PT/PTT
400
What criteria would you look for to have sepsis progress to septic shock (name 2)
1. Vasopressor requirement to maintain MAP>65mmHg
2. Lactate >2 in the absence of hypovolemia
400
Alcoholic sailor who develops high grade fever hours after cutting his foot while sailing in the ocean. His cut is surrounded by hemorrhagic bullae. What is the most likely microorganism?
Vibrio Vulnificus
400
Why is clindamycin used in the treatment of necrotizing soft tissue infections?
toxin suppression of group A strep (DNase and streptolysin O)
400
What is the target glucose for a septic patient?
BG <180mg/dl
400
Which vasopressor may lead to a rise in lactate despite evidence of increased perfusion?
Epinephrine
500
Name 2 of the 4 initial steps to be taken if you suspect sepsis/septic shock by the 3h mark
1. initial lactate (and 3h follow up)
2. blood cultures prior to abx
3. 30ml/kg of IV fluids
4. broad spectrum abx
500
What microorganisms would you suspect in an individual with meningitis who is immunocompromised (name the 3 out of 4)
Strep. pneumoniae
Listeria
Gram Neg Rods (psuedomonas aeruginosa)
N. Meningitidis
500
In what type of septic patient would you consider adding fungal coverage?
Neutropenic patients
500
You have given 30ccs/kg of IV fluids, started multiple vasopressors and your patient remains hypotensive, what is the next therapy you may consider?
Stress dose glucocorticoids (200mg/day or 50mg q6h of hydrocortisone)
500
Which is a better marker of adequate resuscitation in sepsis, lactate clearance or continuous Scvo2 monitoring?
The Jones trial showed that lactate clearance is non-inferior to continuous Scvo2 monitoring used in the often-cited Rivers trial