Sepsis Definitions (Sepsis-3)
- Sepsis: Life-threatening organ dysfunction caused by dysregulated host response to infection
- SOFA Score ≥2 points = Organ dysfunction
- qSOFA (Quick SOFA): RR ≥22, AMS, SBP ≤100 - screening tool
- Septic Shock: Sepsis + vasopressors needed to maintain MAP ≥65 + lactate >2 despite fluids
Sepsis Hemodynamic Profile
- Early (warm) shock: Low SVR, High CO, warm extremities, bounding pulses
- Late (cold) shock: Low SVR, Low CO, cool extremities, poor perfusion
- Elevated lactate indicates tissue hypoperfusion
- SvO2 may be high early (cells not extracting O2) then low
Hour-1 Bundle
- Measure lactate level
- Obtain blood cultures before antibiotics
- Administer broad-spectrum antibiotics
- Begin rapid fluid resuscitation (30 mL/kg crystalloid for hypotension or lactate ≥4)
- Apply vasopressors if hypotensive during/after fluid resuscitation
Sepsis Management
- Source control: Drain abscesses, remove infected devices
- Norepinephrine: First-line vasopressor
- Add vasopressin if refractory (not titrated)
- Consider hydrocortisone for refractory shock
- Target MAP ≥65 mmHg
- Reassess fluid responsiveness (avoid over-resuscitation)
Can you answer these 3 CCRN questions?
Here are 3 questions from our premium bank. The full rationale explains exactly why the right answer is right — and why the 3 distractors trap most test-takers.
A 71-year-old arrives with dyspnea and chest pressure. Skin is cool and clammy. VS: HR 118, BP 78/44, SpOâ‚‚ 92% on 4 L NC. Crackles present bilaterally. Hemodynamics: CI 1.7, CVP 18, PAOP 24, SVR 1750, SvOâ‚‚ 54%. Which shock type best fits?
- Hypovolemic
- Distributive (early septic)
- Cardiogenic
- Neurogenic
A patient on an IABP reports worsening chest pain. The arterial waveform shows balloon deflation occurring after the next systolic upstroke begins, and assisted systolic pressure appears higher than expected. What is the most likely problem/effect?
- Early inflation → decreased coronary perfusion
- Late inflation → decreased diastolic augmentation
- Late deflation → increased afterload and myocardial oxygen demand
- Early deflation → improved unloading
A 63-year-old is 24 hours post–inferior MI. Suddenly develops acute respiratory distress, frothy sputum, hypotension, and a new loud holosystolic murmur at the apex. SpO₂ 84% on NRB. What is the most likely cause?
- Acute pericarditis
- Papillary muscle rupture → acute severe mitral regurgitation
- Right ventricular infarct causing preload collapse
- Dressler syndrome
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