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Chapter 82. Sepsis and Septic Shock

AB is a 75-year-old patient who presents from his nursing home with a urinary tract infection. He is febrile with a temperature of 39.1oC, a heart rate of 102 beats/min, respiratory rate of 12 breaths/min, and a blood pressure of 135/75 mm Hg. Which of the following does AB meet criteria for?

A. Systemic inflammatory response syndrome (SIRS)

B. Bacteremia

C. Septic shock

D. Disseminated intravascular coagulation (DIC)

Select the laboratory test(s) that should be ordered for AB.

A. Complete blood count with differential

B. Comprehensive metabolic panel

C. Urinalysis with culture and gram stain

D. All of the above

AB’s blood pressure begins to decline. His current blood pressure is 101/50 mm Hg and you wish to administer a fluid challenge. What type of fluid(s) do you recommend?

A. 25% albumin

B. Crystalloids

C. Hydroxyethyl starch

D. 5% dextrose

Select the target goal for fluid resuscitation.

A. Central venous pressure 8 to 12 mmHg (1.1–1.6 kPa)

B. Mean arterial pressure greater than or equal to 65 mm Hg (8.6 kPa)

C. Urine output greater than or equal to 0.5 mL/kg/h

D. All of the above

AB is diagnosed with a urinary tract infection and is ordered to start antibiotics. What should be ordered and completed prior to initiation of antibiotics (if possible)?

A. Stress ulcer prophylaxis

B. DVT prophylaxis

C. Microbiologic cultures

D. Norepinephrine

Despite appropriate fluid resuscitation, AB remains hypotensive and his current blood pressure is 90/45 mm Hg. Which vasopressor agent do you recommend to initiate?

A. Norepinephrine

B. Dopamine

C. Epinephrine

D. Phenylephrine

After initiating norepinephrine, AB continues to ...

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