Second Chance - Sepsis | Take the Quiz

Along with suspected infection + addnl criteria, what qualifies for septic shock?

SBP < 90mmHg

MAP < 70mmHg

SBP decrease > 40 mmHg

A change in SOFA score of what number from baseline indicates organ dysfunction?

What empiric therapy should be started? (SELECT ALL THAT APPLY)

Vanco

Pip/tazo

Tobra

Levo

If only 1 IV line, what abx to start first and how soon from arrival should it be started?

Gram-negative coverage with 1 hour

Gram-positive within 1 hour

What is anticipated duration of tx? day 1 = day of appropriate abx given, incl empiric

7-10 days

10-14 days

What if bacteria (+), what is duration of tx?

14 days from first negative blood culture

What are the hemodynamic goals for initial resuscitation?

CVP 8-12 mmHg

MAP > 65 mmHg

UO > 0.5ml/kg/hr

What is an appropriate crystalloid fluid to give?

NaCl 30ml/kg at a rate of 1L/30min

Albumin

What percentage of NaCl stays in intravascular space?

25%

50%

History of multi-drug resistant gram negative infection/colonization within past 90 days or Prior IV broad spec for >72hrs within last 14 days.

Meropenam + Vanco + Amikacin if no beta-lactam allergy

Aztreonam + Vanco + Amikacin + Tigecyclin if beta-lactam allergy

What to add if possible intra-abd catastrophy?

Micafungin

What to do if no risk factors empirically?

Pip/tazo + Vanco + Tobramycin if no beta-lactam allergy

Aztreonam + Vanco + Tobra if beta-lactam allergy

If NE does not work, what should be given next?

Vasopressin - supplements inadequate endogenous vasopressin

Epi

When should hydrocortisone 50mg IV q6hrs be used?

When NE + Epi + Vasopressin on board

When NE + Vasopressin on board

When Vasopressin + Epi on board

What if HR and MAP resolved but SCVO2 and CO are still low?

Add dobutamine (inotropic, potent beta1 agonist)

NEVER USE MILRINONE

What to do if patient develops a-fib from NE?

Phenylephrine (can worsen HF)

Titrate down NE

Second Chance - Sepsis

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