1. Sepsis Tutoring
By Alaina Darby

2. BG is a 34 yo WF who was treated for a UTI within the last 2 weeks
BG is a 34 yo WF who was treated for a UTI within the last 2 weeks. She is coherent and complains of feeling ill. How would you diagnose her?
Vitals:
RR 20
Temp 38.8
HR 105
BP 82/62
Recurrent infection
Sepsis likely due to past infection
Sepsis likely due to new infection
Septic shock a

3. BG is a 34 yo WF who was treated for a UTI within the last 2 weeks
BG is a 34 yo WF who was treated for a UTI within the last 2 weeks. She returns the next day with trouble speaking and forming coherent thoughts. How would you diagnose her now?
Vitals:
RR 20
Temp 38.8
HR 105
BP 82/62
Recurrent infection
Sepsis likely due to past infection
Sepsis likely due to new infection
Septic shock b

4. Infection Sepsis Septic Shock qSOFA (>2): GCS<15 SBP<100
RR>22
Despite adequate volume:
Vasopressors required for MAP>65
Serum lactate >2

5. qSOFA vs SIRS qSOFA SIRS GCS <15 SBP <100 RR >22
Temp >38C or <36C
HR >90
WBC >12,000 or <4000 or 10% bands
RR>20

6. BG is a 34 yo WF who was treated for a UTI within the last 2 weeks
BG is a 34 yo WF who was treated for a UTI within the last 2 weeks. She returns the next day with trouble speaking and forming coherent thoughts. What is the likely source of her bacteremia?
Vitals:
RR 20
Temp 38.8
HR 105
BP 82/62
Intravascular
Lymphatics
Injury
Reticuloendothelial system b

7. Which of the following is most associated with initiation of the inflammatory response?
Cytokines
Toll like receptors
Immunoglobulins
Bradykinin b

8. Toll like receptors can be activated by which of the following?
Peptidoglycan in gram negative bacteria
Exotoxins in gram negative bacteria
Peptidoglycan in gram positive bacteria
Exotoxins in gram positive bacteria c

9. Which of the following are not consequences of the cyclooxygenase and lipoxygenase pathways?
Apoptosis
Mitochondrial damage
Susceptibility to secondary infection
MODS c

10. JD presents with lactic acidosis and ARDS
JD presents with lactic acidosis and ARDS. What other symptoms might you expect in this patient?
Tachycardia
Tachypnea
Leukocytosis
Hypotension d

11. Stages of Sepsis Early (Increase) Late (Decrease) HR RR Bilirubin WBCBG
Temp
UOP
WBC
HR/CO BP BG
GCS

12. BG is a 34 yo WF who was treated for a UTI within the last 2 weeks
BG is a 34 yo WF who was treated for a UTI within the last 2 weeks. What should you do first in treatment?
Vitals:
RR 20
Temp 38.8
HR 105
BP 82/62
Give fluids
Take cultures
Start antibiotics
Start vasopressors a

13. BG is a 34 yo WF who was treated for a UTI within the last 2 weeks
BG is a 34 yo WF who was treated for a UTI within the last 2 weeks. What type of fluid treatment should she receive?
Vitals:
RR 20
Temp 38.8
HR 105
BP 82/62
Labs:
Hgb 9.8
Plt 322 NS
Hetastarch
PRBCs
Albumin A
Be careful on LR even though it is a crystalloid!!

14. BG is a 34 yo WF who was treated for a UTI within the last 2 weeks
BG is a 34 yo WF who was treated for a UTI within the last 2 weeks. What if her BP does not respond to initial fluid therapy?
Vitals:
RR 20
Temp 38.8
HR 105
BP 82/62
Give a different type of fluid
Start norepinephrine
Start epinephrine
Start vasopressin b

15. BG is a 34 yo WF who was treated for a UTI within the last 2 weeks
BG is a 34 yo WF who was treated for a UTI within the last 2 weeks. You take cultures and want to begin therapy. What is the most likely pathogen in this patient?
Vitals:
RR 20
Temp 38.8
HR 105
BP 105/82
S. aureus
E. coli
Candida
S. epidermidis b

16. BG is a 34 yo WF who was treated for a UTI within the last 2 weeks
BG is a 34 yo WF who was treated for a UTI within the last 2 weeks. You take cultures and want to begin therapy. What antibiotic treatment should you initiate?
Vitals:
RR 20
Temp 38.8
HR 105
BP 105/82
Ceftriaxone
Zosyn
Vancomycin
Cipro + metronidazole a

17. BG is a 34 yo WF who was treated for a UTI within the last 2 weeks
BG is a 34 yo WF who was treated for a UTI within the last 2 weeks. Her blood cultures come back negative. What should you do?
Vitals:
RR 20
Temp 38.8
HR 105
BP 82/62
Continue empiric antibiotics
Increase antibiotic spectrum
Discontinue antibiotics
Reassess how the cultures were taken
d… then c

18. IV has a history of drug abuse
IV has a history of drug abuse. What is the most likely pathogen for his sepsis?
S. aureus
E. coli
Candida
S. epidermidis a

19. IC has HIV. What pathogen is more likely to cause sepsis in this patient than someone without HIV?
S. aureus
E. coli
Candida
S. epidermidis c

20. BF has been diagnosed with sepsis following a medical procedure
BF has been diagnosed with sepsis following a medical procedure. What is the treatment of choice for correcting his blood pressure?
Vitals:
RR 27
Temp 38.6
HR 109
BP 91/52
Labs:
Hgb 6.2
Plt 152 NS
Hetastarch
PRBCs
Albumin c

21. BF has been diagnosed with sepsis following a medical procedure
BF has been diagnosed with sepsis following a medical procedure. What adjunct or alternative agent could be considered?
Vitals:
RR 27
Temp 38.6
HR 109
BP 91/52
Labs:
Hgb 6.2
Plt 152
Erythropoietin
Fresh frozen plasma
Platelet transfusion
None d

22. BF has been diagnosed with sepsis following a medical procedure
BF has been diagnosed with sepsis following a medical procedure. What would you treat him with if the medical procedure had been a CABG due to STEMI?
Vitals:
RR 27
Temp 38.6
HR 109
BP 91/52
Labs:
Hgb 6.2
Plt 152 NS
Hetastarch
PRBCs
Albumin a

23. What you should/shouldn’t do…
Don’t:
MV (potentially)
Minimal sedation/analgesia
BG control (<180)
CRRT for AKI
VTE prophylaxis (LMWH/heparin)
Stress ulcer prophylaxis (PPI/H2RA)
Aspirin (probably)
Immunoglobulins
Intensive insulin therapy
Bicarb
Immune stimulation
Esmolol (who knows??)