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What is usually the 1st sign of sepsis?
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What are some risk factors for developing sepsis?
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Immunocompromised, chemo, alcoholic, indwelling lines, antibiotic use, and/or very old/young.
What are signs and symptoms of liver failure r/t sepsis/MODS?
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Jaundice, increased liver enzymes, decreased albumin, and increased NH3 (ammonia).
What metabolic changes are seen with severe sepsis and/or MODS?
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1st: serum lactate higher than 4, ABG less than 7.30, BE over 5.0. *Metabolic acidosis
What lab is the earliest indicator of inadequate tissue perfusion r/t sepsis/MODS?
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Serum lactate; normal 0.56-2.2 and MODS greater than 4.
What pulmonary signs are seen with severe sepsis/ MODS?
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PaO2/FiO2 less than 250; O2 stats less than 92 on 6L O2.
What are signs and symptoms of severe sepsis/ septic shock?
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Decreased CO, tachycardia, SBP less than 90, MAP less than 65, decreased from baseline by 40 SBP, and/or refractory hypotension despite fluids.
What are signs and symptoms of severe sepsis?
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Decreased LOC, U/O less than 0.5 mL/kg/hr, hyperglycemia, hypoxemin, coagulopathy (INR over 1.5), gastricileus, and/or lactate over 2.
What SNS effects are seen from the stress of severe sepsis?
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Decreased GI mobility and increased BMR. Decreased insulin secretion and insulin resistance leads to increased glucose.
How is the GI system impacted by severe sepsis?
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Decreased mobility leads to distention and paralytic ileus. Decreased perfusion leads to ulceration and/or bleeding. Increased risk of bacterial translocation.
What is the criteria for SIRS?
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Body temperature below 96.8 or higher than 100.4, HR over 90, hyperventilation (RR higher than 20), PaCO2 under 32 and WBCs below 4,000 or higher than 12,000.
_______ is a recombinant form of human activated protein C (CRP). It works by...
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Xigris/drotrecoginalfa; increased fibrinolysis leads to increased tissue perfusion and decreases inflammatory response.
If the lungs and other organs fail r/t sepsis, the PaO2/FIO2 is usually _______.
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less than 250
What symptoms of sepsis are r/t the increased platelet activation caused by cytokine release?
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Microthombi leads to hypoperfusion of tissues that leads to anaerobic metabolism leading to acidosis, tissue necrosis, and organ failure.
If the lung is the only failed organ due to sepsis, the PaO2/FIO2 is usually _______.
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less than 200
How is the renal system impacted by severe sepsis/ MODS?
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1st system to fail unless pneumonia is present. Urine output 0.5 mL/kg/hr and increase in creatinine 0.5 mg/dL.
_______ is the term for acute failure of 2 or more organ systems.
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For patients with septic shock, hydrocortisone is given _______mg/day in _______ divided doses, for _______ days.
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200-300 mg; 3-4 divided doses; 7 days
Hypotonic solutions should not be given to people with...
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Increased ICP and third spacing
SIRS can be triggered by infection and _______, meaning SIRS is possible without having to be septic.
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trauma, burns, MI, pancreatitis or other inflammatory process
What are 2 common findings associated with sepsis?
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Infection with decreased BP.
What hematological labs are seen with severe sepsis/MODS?
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Thrombocytopenia (p/t below 80,000), 50% decline in p/ts over 3 days, increased PT/INR, increased PTT, increased K+, decreased protein C, and increased D-dimer.
What causes the bleeding associated with severe sepsis/MODS?
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Fibrin split products (FSP) or fibrin degradation products (FDP) are released to breakdown microthrombi. Too much is released leading to bleeding.
Doses of Vasopressin/ Pitressin to induce vasoconstriction and increase BP shouldn't exceed _______.
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0.04 units/minute (risk of MI and cardiac arrest)
What are the goals within the 1st 6 hours for a septic patient?
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BP over 65 (MAP) and U/O increased (fluids); CVP 8-12 via central line; blood cultures (2 from 2 sites, one which is peripheral); and IV abx within 1 hour of diagnosis.
What symptoms of sepsis are r/t the vasodilation caused by cytokine release?
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Hypotension and drop in body temperature ( cold sepsis ).
An increased risk of death is associated with sepsis patients with what factors?
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APACHE II score over or equal to 25, vasopressors, and/or 2 or more dysfunctional organs.
What symptoms of sepsis are r/t the increased capillary permeability caused by cytokine release?
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3rd spacing and contributes to hypotension.
A serum lactate level greater than _______ is indicative of decreased tissue perfusion r/t sepsis.
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What is the underlying pathology of a SIRS/sepsis infection?
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The body is unable to localize the infectious agent. Endotoxins are released and enter the bloodstream. Excessive immunomodulators are released resulting in an exaggerated systemic response.

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