Bsnc 6000 module 10: sepsis
Sepsis definition - answerlife threatening organ dysfunction caused by a dysregulated host
response to infection
12th leading cause of death worldwide
Sepsis Network: BC has had 10x less in-hospital sepsis cases and 8x less sepsis related deaths
compared to the rest...
BRIGHTSTARS EXAM STUDY SOLUTIONS 8/15/2024 2:05 PM
Bsnc 6000 module 10: sepsis
Sepsis definition - answer✔✔life threatening organ dysfunction caused by a dysregulated host
response to infection
12th leading cause of death worldwide
Sepsis Network: BC has had 10x less in-hospital sepsis cases and 8x less sepsis related deaths
compared to the rest of Canada
Septic shock definition - answer✔✔A subset of sepsis in which particularly profound
circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality
than with sepsis alone.
Pulse Pressure (calculation, normal numbers) - answer✔✔Calculation: systolic - diastolic = PP.
Normal is 30-40. Numbers above 40 are concerning (around 60 in sepsis)
Mean arterial pressure (calculation, normal numbers) - answer✔✔average arterial pressure
throughout 1 cardiac cycle. Normal is 65+. Calculation: ((SBP-DBP) / 3) + DBP = MAP. MAP
below 65 is concerning.
Manifestations of sepsis (2 vitals, 3 related to SV, 4 related to assessment) - answer✔✔wide
spread edema: blood not staying in vessels, plasma is "leaking" everywhere
fluid in the lungs: fine crackles in all fields bilaterally
decreased/no urine output: insufficient perfusion to kidneys
change in mental status: insufficient perfusion to brain
decreased preload: fluid has left vessels, therefore filling volume/pressure decreased
decreased afterload: nothing to "push" against due to boggy vessels
only way to maintain cardiac output: contractility
increased HR, decreased BP (diastolic will tank more than systolic)
Provide rationale for the following clinical manifestations in sepsis... - answer✔✔
, BRIGHTSTARS EXAM STUDY SOLUTIONS 8/15/2024 2:05 PM
Low temperature - answer✔✔hypothermia related to decreased metabolic demand
HR 105, BP 95/40 - answer✔✔diastolic = decrease fluid in vessels = compensatory increased
HR
RR 28, SpO2 92% on RA - answer✔✔low O2 getting into pulmonary circulation = high RR (or
PSR, or metabolic/lactic acidosis)
Drowsy but rousable - answer✔✔CNS isnt perfused or toxin buildup
Skin is warm and flushed - answer✔✔lots of blood in skin, but body is hypothermic &
hypotensive
Pedal pulses are unusually strong and bounding - answer✔✔strong pulses in setting of
hypotension → high contractility
Both hands and feet are swollen - answer✔✔peripheral edema in setting of hypotension
Moderate productive cough with yellow sputum - answer✔✔infection in lungs (cause or result of
sepsis?)
Crackles heard through bilateral lung fields - answer✔✔fluid, infection, and/or inflammation in
lungs
20 ml yellow urine/6h - answer✔✔oliguria in hypotension = kidneys are shutting down and
toxins are building up
WBC 18.6 - answer✔✔leukocytosis due to infection and/or inflammation
Abnormally low platelet - answer✔✔due to loss, consumptions, or decreased production? (must
figure out)
Fluid is not in the vasculature (evidence, rationale) - answer✔✔evidenced by low diastolic and
low perfusion in kidneys and brain. Fluid is falling out of vasculature due to widespread
inflammation. Fluid is in tissues and lungs (evidence: swollen limbs, crackles, productive
cough). Blood is in peripheral tissue (evidence, skin is warm and flushed).
Heart is compensating for low blood volume (evidence, con) - answer✔✔evidenced by bounding
pulses and high HR. Con: systolic is 95 but its the best it can do with low preload.
Signs of infection/inflammation (evidence, con) - answer✔✔evidenced by high WBC,
productive cough, and warm skin. Con: hypothermia, the body is trying to reduce metabolic
demand.
Thrombocytopenia (rationale) - answer✔✔production is probably fine as RBC can be made.
Loss unlikely due to no sign of external or internal bleed (also, skin would not be warm/flushed
if there's a hemorrhage. Sequestered is unlikely if there are no signs of splenomegaly or
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