Management of Sepsis Zaka U. Khan, MD, and Gary A. Salzman, MD Dr. Khan is a fellow in pulmonary and critical care medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO. Dr. Salzman is a professor of medicine, University of Missouri-Kansas City School of Medicine, and chief, Department of Respiratory and Critical Care Medicine, Truman Medical Center, Kansas City, MO. The questions below are based on the article “Management of Sepsis: The Surviving Sepsis Guidelines for Early Therapy”. Choose the single best answer for each question.
	Questions 1 and 2 refer to the following case. A 45-year-old woman presents to the emergency department with acute pancreatitis related to a history of gallstones. The patient’s vital signs are as follows: temperature, 98°F; heart rate, 120 bpm; respiratory rate, 30 breaths/min; blood pressure, 70/35 mm Hg; and oxygen saturation as measured by pulse oximetry, 98% without oxygen supplementation. A chest radiograph is normal. White blood cell count is 12 × 103/µL, and urinalysis is unremarkable. No other sources of infection are identified. 1. This patient’s condition can best be defined as which of the following? Multiorgan dysfunction syndrome Sepsis Septic shock Severe sepsis Systemic inflammatory response syndrome Click here to compare your answer. 2. After ensuring adequate airway and oxygenation, what is the next step in the management of this patient? Antibiotic therapy á-Blocker therapy to control heart rate Intravenous fluid resuscitation Surgical consult for gall bladder surgery Vasopressor therapy with dopamine Click here to compare your answer. 3. All of the following therapies for septic shock have been shown to improve survival in randomized controlled trials EXCEPT? Low tidal volume mechanical ventilation in patients with acute respiratory distress syndrome (ARDS) Early goal-directed therapy for initial resuscitation Use of recombinant human activated protein C (drotrecogin alfa [activated]) in patients with an Acute Physiology and Chronic Health Evaluation (APACHE II) score < 25 Tight glucose control in postsurgical patients Starting corticosteroid therapy more than 2 weeks after the onset of ARDS Click here to compare your answer.		4. Which of the following is a contraindication to the use of drotrecogin alfa? APACHE II score < 25 Platelet count of 40 × 103/µL History of hemorrhagic stroke within the previous 6 months Intracranial neoplasm Intraspinal surgery within the previous 4 months Click here to compare your answer . 5. Which of the following is an indication for using corticosteroids in septic shock? ARDS Necrotizing pneumonia Peritonitis Sepsis responding well to fluid resuscitation Vasopressor-dependence Click here to compare your answer. 6. In the treatment of septic shock, what is the goal for blood pressure? Systolic blood pressure ≥ 90 mm Hg Mean arterial pressure ≥ 65 mm Hg Diastolic blood pressure ≥ 60 mm Hg Systolic blood pressure ≥ 80 mm Hg Diastolic blood pressure ≥ 40 mm Hg Click here to compare your answer. 7. In the treatment of septic shock, what is the goal for urine output? Urine output ≤ 0.3 mL/kg/hr Urine output ≥ 0.2 mL/kg/hr Urine output ≥ 300 mL per day Urine output ≥ 0.5 mL/kg/hr Urine output ≥ 1 mL/kg/hr Click here to compare your answer.
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