Bundle Elements
A patient presents with severe sepsis at 14:35. Name the nurse-driven bundle elements that do not require a physician order.
What is blood cxs x2 and lactate?
Alcoholics, untreated GI disease, the elderly
Who is at risk for Sepsis?
Infectious disease physician documents Septicemia, in a patient with no PMH. The patient's labs include a positive blood culture growing MRSA, and a WBC of 9.0. Vital signs are Temp: 98.6, HR: 80, RR: 20, BP: 110/80 and an oxygen saturation of 100% on room air.
What is a query for clinical validation of Sepsis.
Sepsis + hypoperfusion, despite fluid resusciation
What is Septic Shock
Perfusion
What is the main problem in sepsis?
Zosyn and Vancomycin are often ordered simultaneously. If you have a line access issue, this medication should be given first.
What is Zosyn?
Known or suspected infection and 2 or more SIRS criteria
What is Sepsis?
Nephrology physician documents Sepsis, in a patient with a urinary tract infection likely due to bilateral nephrostomy tunes. Laboratory results: WBC of 13, platelets of 90, and a creatinine of 1.5. The patients Vital signs include: Temp: 101F, HR: 100, RR: 20, a blood pressure of 120/80.
Late indicator of shock
What is hypotension
Gram Negative Bacteria Gram Positive Bacteria Fungi Viruses
What the causative microorganisms of sepsis?
You implement the severe sepsis bundle on your patient who becomes hypotensive with lactate of 21, but they are unable to tolerate fluid resuscitation due to CHF. Name 1 alternative bundle element required to address the hypotension.
What are vasopressors?
immune/inflammatory response is not localized to area around antigen
What is the body's response in sepsis?
Internal Medicine Physician documents Severe Sepsis with septic shock. The patient's presents with cellulitis of the right lower extremity. Labs include a WBC of 3.0, with VS in the ER of: Temp: 103 F, HR 110, RR 30, BP: 80/50. Fluid bolus of 30 ml/kg was administered and the patients BP recovered. However 1 hour later the BP dropped, and another round of fluids of 30 ml/kg was administered, with improvement of BP back to baseline.
What is a clarification query for clinical validation of severe sepsis with septic shock.
Dimished pulses, mottled skin, decreased Cardiac Output
What is "Cold" Shock
Altered Level of consciousness
What is a SIRS criteria?
This bundle element is often forgotten by the physicians but is required DOCUMENTATION after a patient is treated for septic shock.
What is volume and tissue perfusion assessment?
Decreased blood flow to organ tissue
What is the body's response in sepsis?
Patient was diagnosed with UTI due to chronic indwelling foley by the ED physician. The patient presented with flank pain, a Temp of 95.8, HR 110, RR 22, and WBC of 15. On Hospital day 4, Sepsis due to UTI secondary to chronic indwelling foley was documented by the Internal Medicine Physician.
What is a clarification query for POA of sepsis.
Often used in Normotensive septic patients to improved blood flow via vasodilation
What is Dopamine
Fibrin clots lead to microvascular hypoperfusion, diminished oxygen delivery and tissue necrosis
What is part of the body's response in sepsis?
Burns, trauma, pancreatitis
What are SIRS with no evidence of infection?
Patient presented for elective right kidney transplant. On post op day 3 the patient developed a temperature of 103, with a heart rate of 100, RR of 26, BP 110/80 and 99% oxygen sat on R/A. Labs revealed WBC of 18 and Urinalysis was positive for UTI. Urology diagnosed the patient with Sepsis due to UTI.
What is a query for the relationship between the infection and the surgical procedure.
Vasoconstrictor that increases cardiac contractility w/ out negative effects on HR
What is Norepinephrine
Lactate >4
What is an indication of severe sepsis requiring EGDT?