MICU EXAM QUESTIONS & ANSWERS
SIRS Criteria - Answer -≥2 of the following:
- Temp >38 or <36
- HR >90
- RR >20 or PaCO2 <32
- WBC >12k, <4k or >10% bands
Identifies severe sepsis & significant risk of death - Answer -organ dysfunction
Organ dysfunction signs - Answer -1. Lactate above ULN
2. Renal insuff:
- UO <0.5 mL/kg/h for >2h despite IVFs
- SCr >2
3. Acute lung injury: PaO2/FIO2 <200
4. Hepatic insufficiency: bili >2
Most common cause of death in patients with severe sepsis - Answer -multisystem
organ failure
(probability of death increases and number of failing organs increases)
Organ failure: Carry the highest independent risk of death in septic shock - Answer -
liver & renal
Determinants of Mortality in Sepsis
(Management of these risks = SOC) - Answer -1. Early recognition
2. Appropriate abx tx w/in 1h of hypotension
3. Source control
4. Resuscitation, reestablishing perfusion w/in 6h of onset of hypotensive shock
lactate of how much that does not correct in 6h correlates with mortality? - Answer ->4
Initial fluid resuscitation for sepsis
- how much?
- for who? - Answer -- crystalloids 30mL/kg bolus
- lactate >2, hypotensive
[Sepsis]: Assessing volume status after initial bolus - Answer -Repeat PE
2 of the following assessments of perfusions:
- CVP (goal = 8-12)
- SCVO2 >70%
- CV US & IVC measurement (goal diameter 1.5-2.5cm or <50% collapse during
inspiration)
- Assessment of fluid responsiveness (passive leg raise testing)
, [Sepsis] Ultimate goal for IVF resuscitation response - Answer -MAP >65
Normalizing lactate
[Sepsis] Consider for double coverage of GN organisms - Answer -Neutropenia
Multidrug resistant GN organisms
[Sepsis] Biomarker that may aid in stopping empiric abx if no infection source is
identified - Answer -procalcitonin
[Sepsis] Pressor associated with increased adverse events (increased mortality) -
Answer -dopamine
(vs. levo)
[Sepsis] Second line pressor
(not used as monotherapy) - Answer -vasopressin
[Sepsis] 3rd line pressor - Answer -epi
- can add or replace levo
[Sepsis] When to use steroids - Answer -poorly responsive to IVF & pressors
[Sepsis] When are steroids NOT indicated? - Answer -sepsis w/o septic shock
[Sepsis] Steroid dosing for fluid resuscitated vasopressor resistant shock - Answer -
hydrocortisone 200-300 mg/d
(If non-hydro used, +fludro 50 qd)
(ACTH stim test not rec.)
Surviving Sepsis Guidelines - Answer -1st 3h:
- Lactic acid lvl
- BCx (before abx)
- BS-Abx
- 30 mL/kg IVF for hypotension or lactate >4
1st 6h:
- Pressors to maintain MAP >65
- Persistent hypotension or lactate >4 despite resuscitation , reassess vol status via:
- repeat PE
- 2 other assessment methods (CVP, IVC measurement, etc...)
- Re-measure lactate if initial elevated
End stage of untreated or insufficiently treated hypothyroidism - Answer -myxedema
coma
SIRS Criteria - Answer -≥2 of the following:
- Temp >38 or <36
- HR >90
- RR >20 or PaCO2 <32
- WBC >12k, <4k or >10% bands
Identifies severe sepsis & significant risk of death - Answer -organ dysfunction
Organ dysfunction signs - Answer -1. Lactate above ULN
2. Renal insuff:
- UO <0.5 mL/kg/h for >2h despite IVFs
- SCr >2
3. Acute lung injury: PaO2/FIO2 <200
4. Hepatic insufficiency: bili >2
Most common cause of death in patients with severe sepsis - Answer -multisystem
organ failure
(probability of death increases and number of failing organs increases)
Organ failure: Carry the highest independent risk of death in septic shock - Answer -
liver & renal
Determinants of Mortality in Sepsis
(Management of these risks = SOC) - Answer -1. Early recognition
2. Appropriate abx tx w/in 1h of hypotension
3. Source control
4. Resuscitation, reestablishing perfusion w/in 6h of onset of hypotensive shock
lactate of how much that does not correct in 6h correlates with mortality? - Answer ->4
Initial fluid resuscitation for sepsis
- how much?
- for who? - Answer -- crystalloids 30mL/kg bolus
- lactate >2, hypotensive
[Sepsis]: Assessing volume status after initial bolus - Answer -Repeat PE
2 of the following assessments of perfusions:
- CVP (goal = 8-12)
- SCVO2 >70%
- CV US & IVC measurement (goal diameter 1.5-2.5cm or <50% collapse during
inspiration)
- Assessment of fluid responsiveness (passive leg raise testing)
, [Sepsis] Ultimate goal for IVF resuscitation response - Answer -MAP >65
Normalizing lactate
[Sepsis] Consider for double coverage of GN organisms - Answer -Neutropenia
Multidrug resistant GN organisms
[Sepsis] Biomarker that may aid in stopping empiric abx if no infection source is
identified - Answer -procalcitonin
[Sepsis] Pressor associated with increased adverse events (increased mortality) -
Answer -dopamine
(vs. levo)
[Sepsis] Second line pressor
(not used as monotherapy) - Answer -vasopressin
[Sepsis] 3rd line pressor - Answer -epi
- can add or replace levo
[Sepsis] When to use steroids - Answer -poorly responsive to IVF & pressors
[Sepsis] When are steroids NOT indicated? - Answer -sepsis w/o septic shock
[Sepsis] Steroid dosing for fluid resuscitated vasopressor resistant shock - Answer -
hydrocortisone 200-300 mg/d
(If non-hydro used, +fludro 50 qd)
(ACTH stim test not rec.)
Surviving Sepsis Guidelines - Answer -1st 3h:
- Lactic acid lvl
- BCx (before abx)
- BS-Abx
- 30 mL/kg IVF for hypotension or lactate >4
1st 6h:
- Pressors to maintain MAP >65
- Persistent hypotension or lactate >4 despite resuscitation , reassess vol status via:
- repeat PE
- 2 other assessment methods (CVP, IVC measurement, etc...)
- Re-measure lactate if initial elevated
End stage of untreated or insufficiently treated hypothyroidism - Answer -myxedema
coma
