Severe sepsis plus: NEED ONLY ONE
*****Hypotension < 90 mmHg or MAP < 65 mm AFTER fluid bolus of 30mL/kg
OR
*****Initial lactic acid level > or equal to 4mmol/L
What is Septic Shock
100
If SBP < 90 or MAP < 65mmHg or Lactic Acid > 4mmol/L give NS 30mL/kg bolus
*Should we include that we have identified severe sepsis*
What is the Initial Fluid Resuscitation within the 3hr bundle?
100
When I have a septic patient admitted to Med/Surg how do I know when to escalate care.
What is increase in respiratory rate over 22, any change in ALOC, and/or SBP less than 100 (any two of these)
100
Severe Sepsis + hypoperfusion, despite fluid resuscitation
What is Septic Shock
100
Hypoxia and hypercarbia are signs of what organ failing
What are the lungs/respiratory system
200
Suspected infection plus 2 or more SIRS criteria
What is SEPSIS
200
*Measure Lactic Acid*
*Obtain blood cultures*
*Initiate broad spectrum antibiotics*
*Fluid bolus 30mL/kg If SBP < 90 or MAP < 65mmHg or Lactic Acid > 4mmol/L give NS 30mL/kg bolus*
What is the 3 hr bundle for Severe Sepsis or Septic Shock
200
When you have a lactate over 2mmol when do you need recheck the lactate again?
What is 3 hrs?
200
If fluid resuscitation efforts are not enough, the following intervention may be necessary.
What is vasopressor therapy?
200
You were working on the farm the other day and cut your finger when you were cleaning out the horse stall. Initially it hurt, and was a bit red and slightly swollen. This morning when you woke, you noticed your finger is more sore and swollen. This response is known as what?
What is Inflammatory Response?
300
Hypotension < 90mm Hg or MAP < 65 mm
Lactic Acid > 2 mM
Creatinine > 2 mg/dL acute increase
Platelets < 100,000
New need for invasive or non-invasive mechanical ventilation
Bilirubin > 2 mg/dL acute increase
INR > 1.5 (not on warfarin)
Urine output <0.5mL/kg x2 hrs despite fluids
What are signs of Organ Dysfunction
300
The "Earliest" time all the elements for severe sepsis or septic shock are present within a 6hr time frame.
What is time zero?
300
What must be drawn before starting antibiotics?
What is blood cultures?
300
This is the correct amount of fluid to give a patient in septic shock
What is 30mL/kg
300
You have been ignoring signs of a bladder infection for the past week. Today you don't feel well, your HR is 130/min and you have a fever of 39 degrees Celsius. This response is known at what?
What is SIRS (Systemic Inflammatory Response Syndrome)
400
Sepsis + 1 Organ Dysfunction
What is Severe Sepsis
400
Your caring for a patient in Med/Surg and has new onset of ALOC, HR 110, RR 28, T 38.8, and a WBC 15,000
What is call a Rapid Response (so the team can evaluate for Sepsis)
400
This lab value, when elevated is an early (and sometimes late) sign of increased oxygen demand on organs/tissues.
What is lactate?
400
Your patient is currently on 100% O2 and SPO2 is only 92%. They sound a bit crackly on auscultation. They have had 5 litres of N/S since admission 4 hours ago. Their BP remains 80/40 and urine output is low, the patient is not fluid responsive. They have pneumonia. The following intervention is most likely.
What is vasopressor therapy?
400
What lab do you need to trend until it is less than 2
What is Lactic Acid
500
Vital Signs
BP 110/88
HR 104
T 101.3 F (38.5 C)
RR 24
What is SIRS Alert-(positive Screen)
500
*Vasopressors initiated if not responsive to fluid to maintain MAP >65mm Hg*
*Re-measure Lactic Acid if initial is > 2 mmol/L and every 4 hours until decreased by 20%*
*Attending physician needs to re-assess volume status and tissue perfusion*
What needs to happen in the 6 Hour Bundle?
500
You've been admitted to the ICU after being diagnosed with pneumonia. Your BP 95/50, but getting better with fluid administration, and your creatinine is 2.1 . This condition is known as what?
What is Severe Sepsis?
500
Your Grandmother has been rushed to the ER and diagnosed with pneumonia. Her blood pressure is 70/30, and she her WBC is 14.7. She has a fever of 38.5 degrees Celcius. Her SPO2 on R/A was only 74%, and she was placed on 100% NRB mask. She has been given 4 litres of N/S with no improvement in her BP. The MD has now started on a vasopressor. With the above criteria, what category describes this patient?
What is septic shock?
500
What kind of antibiotic should be hung first, before other antibiotics such as flagyl?
What is a broad spectrum antiotics (such as rocephin, zosyn, or levaquin?