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Chapter 82. Sepsis and Septic Shock

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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?

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A. Systemic inflammatory response syndrome (SIRS)

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B. Bacteremia

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C. Septic shock

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D. Disseminated intravascular coagulation (DIC)

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

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A. Complete blood count with differential

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B. Comprehensive metabolic panel

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C. Urinalysis with culture and gram stain

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D. All of the above

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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?

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A. 25% albumin

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B. Crystalloids

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C. Hydroxyethyl starch

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D. 5% dextrose

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Select the target goal for fluid resuscitation.

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

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

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

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D. All of the above

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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)?

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A. Stress ulcer prophylaxis

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B. DVT prophylaxis

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C. Microbiologic cultures

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D. Norepinephrine

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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?

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A. Norepinephrine

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B. Dopamine

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C. Epinephrine

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D. Phenylephrine

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After initiating norepinephrine, AB continues to ...

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