BSNC 6000 MODULE 10: SEPSIS VERIFIED
ACCURATE STUDY GUIDE
Sepsis definition - Answers - 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 - Answers - 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) - Answers - Calculation: systolic -
diastolic = PP. Normal is 30-40. Numbers above 40 are concerning (around 60 in
sepsis)
Mean arterial pressure (calculation, normal numbers) - Answers - 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) - Answers -
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... - Answers -
Low temperature - Answers - hypothermia related to decreased metabolic demand
HR 105, BP 95/40 - Answers - diastolic = decrease fluid in vessels = compensatory
increased HR
RR 28, SpO2 92% on RA - Answers - low O2 getting into pulmonary circulation = high
RR (or PSR, or metabolic/lactic acidosis)
Drowsy but rousable - Answers - CNS isnt perfused or toxin buildup
, Skin is warm and flushed - Answers - lots of blood in skin, but body is hypothermic &
hypotensive
Pedal pulses are unusually strong and bounding - Answers - strong pulses in setting of
hypotension → high contractility
Both hands and feet are swollen - Answers - peripheral edema in setting of hypotension
Moderate productive cough with yellow sputum - Answers - infection in lungs (cause or
result of sepsis?)
Crackles heard through bilateral lung fields - Answers - fluid, infection, and/or
inflammation in lungs
20 ml yellow urine/6h - Answers - oliguria in hypotension = kidneys are shutting down
and toxins are building up
WBC 18.6 - Answers - leukocytosis due to infection and/or inflammation
Abnormally low platelet - Answers - due to loss, consumptions, or decreased
production? (must figure out)
Fluid is not in the vasculature (evidence, rationale) - Answers - 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) - Answers - 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) - Answers - evidenced by high WBC,
productive cough, and warm skin. Con: hypothermia, the body is trying to reduce
metabolic demand.
Thrombocytopenia (rationale) - Answers - 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 hepatomegaly (must investigate). Likely being consumed, therefore
need to find the clots (risk of DIC)
Overall effects if systemic vasodilation, increased vessel permeability, inappropriate
clotting and maldistribution of clotting, myocardial depression, or cerebral dysfunction
occur? - Answers - systemic vasodilation: shock
ACCURATE STUDY GUIDE
Sepsis definition - Answers - 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 - Answers - 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) - Answers - Calculation: systolic -
diastolic = PP. Normal is 30-40. Numbers above 40 are concerning (around 60 in
sepsis)
Mean arterial pressure (calculation, normal numbers) - Answers - 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) - Answers -
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... - Answers -
Low temperature - Answers - hypothermia related to decreased metabolic demand
HR 105, BP 95/40 - Answers - diastolic = decrease fluid in vessels = compensatory
increased HR
RR 28, SpO2 92% on RA - Answers - low O2 getting into pulmonary circulation = high
RR (or PSR, or metabolic/lactic acidosis)
Drowsy but rousable - Answers - CNS isnt perfused or toxin buildup
, Skin is warm and flushed - Answers - lots of blood in skin, but body is hypothermic &
hypotensive
Pedal pulses are unusually strong and bounding - Answers - strong pulses in setting of
hypotension → high contractility
Both hands and feet are swollen - Answers - peripheral edema in setting of hypotension
Moderate productive cough with yellow sputum - Answers - infection in lungs (cause or
result of sepsis?)
Crackles heard through bilateral lung fields - Answers - fluid, infection, and/or
inflammation in lungs
20 ml yellow urine/6h - Answers - oliguria in hypotension = kidneys are shutting down
and toxins are building up
WBC 18.6 - Answers - leukocytosis due to infection and/or inflammation
Abnormally low platelet - Answers - due to loss, consumptions, or decreased
production? (must figure out)
Fluid is not in the vasculature (evidence, rationale) - Answers - 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) - Answers - 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) - Answers - evidenced by high WBC,
productive cough, and warm skin. Con: hypothermia, the body is trying to reduce
metabolic demand.
Thrombocytopenia (rationale) - Answers - 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 hepatomegaly (must investigate). Likely being consumed, therefore
need to find the clots (risk of DIC)
Overall effects if systemic vasodilation, increased vessel permeability, inappropriate
clotting and maldistribution of clotting, myocardial depression, or cerebral dysfunction
occur? - Answers - systemic vasodilation: shock
