Fluids
What am I?
Bugs and Drugs
Initial Resuscitation
Pressors
100
The initial amount of a fluid bolus required in resuscitation
What is 30 mL/kg
100
D.R. is a 60 kg, 45 yow that arrives to the ED via EMS. Temp 38.5F, BP 70/50 mmHg, HR 92 bpm, RR 22, WBC 15, SCr 3.5. She has received 1L NS en route.
What is severe sepsis
100
This should be drawn before initiation of empiric antibiotic therapy, provided it does not incur significant delay in therapy.
What is 2 sets of cultures (2 aerobic and 2 anaerobic) one from percutaneous and one from vascular access device unless it was placed within 48 hours.
100
If done promptly, this can help confirm potential source of infection
What is an imaging study
100
This is the first line vasopressor
What is norepinephrine
200
This is the indicated type of fluid for resuscitation
What is crystalloid
200
P.U is a 33 yof that presents to her doctor's office for a cough for one week. Her temp is 39C, HR is 104bpm, BP 140/90 mmHg, RR 25, WBC 13. SCr 0.8
What is sepsis
200
This is the time within which initial empiric antibiotics should be administered
What is 1 hour
200
This can be used as a marker for discontinuation of empiric antibiotics if there is no evidence of infection
What is procalcitonin levels or other inflammation biomarkers
200
Target MAP when using vasopressor therapy in patients
What is >= 65 mm Hg
300
This fluid is recommended against in fluid resuscitation in sepsis and septic shock
What is hydroxyethyl starches (HES)
300
I.L is a 45 yo male- presents to the ED via ambulance. Vitals are: BP120/80 mmHg, HR 95 bpm, RR 17, temp 38.5 F, WBC 10, SCr 0.65.
What is SIRS
300
These are three of the factors to consider when choosing initial antibiotics.
What is patient history, drug intolerance, recent antibiotic use, suspected source of infection (underlying disease/clinical syndrome), local (hospital or community)susceptibility patterns, organisms that are known to infect the patient
300
This is one potential strategy to reduce VAP
What is oral decontamincation with chlorhexidine
300
This is the indication for dopamine
What is as an alternative to norepinephrine, only when there is a low risk of tachyarrhythmia and absolute/relative bradycardia
400
This type of fluid may be added if large fluid volumes are needed
What is albumin
400
O.W. is a 49 yom that wanders into the ED confused (No PMH). BP 80/40 mmHg, HR 100 bpm, RR 8, WBC 8, SCr 2.5, and cloudy urine.
What is severe sepsis
400
This is the typical duration of antibiotic therapy for most patients with sepsis
What is 7-10 days
400
This can be uses if invasive candidiasis in in the differential diagnosis
What is 1.3-beta-D-glucan assay, mannan and anti-mannan antibody assay
400
This is the indication for vasopressin use
What is in addition to NE to increase the MAP or decrease the NE dose (not recommended as
500
This fluid should not be used when co-administering blood products
What is lactacted ringers (LR)
500
D.R. is a 60 kg, 45 yow that arrives to the ED via EMS. Temp 38.5F, BP 70/50 mmHg, HR 92 bpm, RR 22, WBC 15, SCr 3.5. She has received 2L NS en route.
What is septic shock
500
This is the time frame and frequency when de-escalation should occur
What is daily after 3-5 days of broad spectrum therapy
500
Goals during the first 6 hours of resuscitation (4)
What is: CVP 8-12 mm Hg, MAP >= 65 mmHG, UO >= 0.5 mL/kg/hr, central venous or venous oxygen saturation 70% or 65% (also normalization of lactate levels)
500
Indication for dobutamine for sepsis
What is attaining adequate MAP and intravascular perfusion with ongoing signs of hypoperfusion and/or signs of cardiac dysfunction
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