SEPSIS

Labs and Protocols

100

name two abnormal labs you would see on a coagulation panel in a sepsis patient

PT/INR elevated

PTT elevated

Platelets and fibrinogen decreased

RBC, Hgb, Hct normal but decreases in progression

200

what acid base imbalance would you most likely see on an ABG for a sepsis patient?

metabolic acidosis 

300

what is the target range for glucose?

140-180

400

what is the three hour bundle protocol?

- Lactic acid 

- Blood cultures 

- Administer abx 

- Administer 30 mL/kg crystalloid fluid bolus if pt was hypotensive or had a lactate >4

-redraw Lactate if initial is >2

500

what is the 6 hour bundle?

- Repeat lactate 

- Start vasopressors  

If Septic shock is met the provider will need to document one of the following: 

- Repeat volume status and tissue perfusion assessment ( physical exam, perfusion assessment, or review of systems) 

- 5 of 8 ( VS, Cardiopulmonary, Cap refill, peripheral pulses, skin exam, urine OP, SpO2, SI) 

- 1 of the following ( CVP, SvO2, Cardiovascular US, Fluid challenge/ passive leg raise)

Stages of Shock

100

This stage is defined by persistent hypotension despite fluids and elevated lactate (>4)

septic shock

200

What are the 2 biggest complications from sepsis? 

MODs and DIC

300

Name 2 signs of organ hypoperfusion

SBP <90 or MAP <65 

SBP decrease of >40 from patients’ baseline 

Acute respiratory failure with need for ventilation 

Creatine >2 OR urine output < 0.5mL/kg/hr for 2 hrs 

Bilirubin >2 

Platelet count <100,000 

INR >1.5 or PTT >60 seconds 

Lactate >2

400

Why do we trend lactate levels and what do they indicate?

to determine if treatment is effective, lactate indicates poor tissue/organ perfusion

500

Name all of the criteria of SIRS

Temp > 100.4 or < 96.8 

HR > 90 

Resp rate >20 

WBCs >12,000 or <4,000

Clinical Signs

100

In elderly patients, this is often the first sign of sepsis.

AMS

200

Urine output less than this amount suggests renal hypoperfusion

<0.5ml/kg/hr 

OR 

<30ml/hr

300

What does the skin look like in the hyperdynamic phase of septic shock?

warm and flushed

400

what does the skin look like in late septic shock

cold and mottled, possible cyanosis

500

This respiratory response occurs as the body compensates for metabolic acidosis.

Tachypnea, may progress to Kussmaul 

Management and Treatment

100

This amount of crystalloid fluid is given initially in severe sepsis or septic shock.

30ml/kg/hr

200

Lactate must be redrawn if the initial level is greater than this value.

2

300

Name 2 broad spectrum antibiotics

Ciprofloxacin

Amoxicillin 

Ampicillin

Vancomycin

400

If hypotension persists after fluids, this class of medication is started.

Vasopressors

500

What is the first line pressor for septic shock?

Levo/Norepinephrine