Sepsis

Question 1

What is sepsis?

Answer 1

Life threatening organ disfunction caused by a disregulated host response to infection

Question 2

What is sepsis a result of?

Answer 2

A systemic inflamatory response

Question 3

What local infections are most likely to precipitate sepsis?

Answer 3

Pneumonia (50%)
UTI (20%)
Abdomen (15%)
Skin soft tissue bone and joint (10%)

Question 4

What disfunction of cytokines contibutes to sepsis?

Answer 4

An excessive amount of cytokines are released which body circulates causing a ‘cytokine storm’

Question 5

What is the principle clotting factor?

Answer 5

Thrombin

Question 6

Where does thrombin come from?

Answer 6

Thrombin stems from a protein called ‘tissue factor’

Question 7

What is the pro-coagulant response during sepsis?

Answer 7

Bacteria and cytokines lead to tissue factor activating the coagulation cascade which ultimately leads to thrombin formation and the impairment of fibrinolysis.
This can lead to abnormal blood clotting throughout the body’s blood vessels which contributes to hypoperfusion, and finally multiple organ dysfunction syndrome

Question 8

How does the inflammatory response contribute to tissue perfusion in sepsis?

Answer 8

Excess fluid disrupts gasseous exchange leading to hypoxia.

The cytokine storm and subsequent dis-regulated immune response can damage vital organs

Question 9

What kind of shock is septic shock?

Answer 9

Distributive

Question 10

What cells release cytokines?

Answer 10

Cytokines are mainly produced by macrophages and lymphocytes, although they can also be produced by polymorphonuclear leukocytes (PMN), endothelial and epithelial cells, adipocytes, and connective tissue.

Question 11

What 3 responses to infection contribute to sepsis?

Answer 11

Host immune response
Inflammatory response
Pro-coagulant response

Question 12

What are signs and symptoms of sepsis?

Answer 12

Fever
Heart rate >90bpm
Tachypnoea >22
Altered mental status
Hyperglycaemia (>7.7mmol) in the absence of diabetes
Hypothermia (known as ‘cold sepsis’) <36ºC

Question 13

What is the NEWS2 score made for?

Answer 13

Detecting clinical deterioration

Question 14

What are sepsis red flags?

Answer 14

Question 15

What are sepsis amber flag?

Answer 15

Question 16

Why is an elevated lactate level a red flag for sepsis?

Answer 16

It is a sign of anaerobic respiration which signifies hypoxia and can lead to metabolic acidosis

Question 17

Why is recent chemotherapy a red flag of sepsis?

Answer 17

Patients are immunosuppressed so their leukocytes are reduced specifically their neutrophils

This is classed as neutropenic sepsis

Question 18

What is the sepsis six?

Answer 18

First line hospital treatment for septic patients on arrival

Question 19

What treament can help septic lactate levels, how?

Answer 19

Fluids, they dilute acids and help maintain a MAP of ≥65mmHg

Question 20

Which septic patients should you be cautious administering fluids to, why?

Answer 20

Patients with congestive heart/cardiac failure, danger of pulmonary oedema

Question 21

What would you give paracetamol for in septic patients, why?

Answer 21

Severe pain/discomfort
Paracetamol is an anti-pyretic, pyrexia is an essential ‘protective physiological response to aid in host defence’

Question 22

What are some common symptoms of increased lactate level?

Answer 22

Early symptoms of lactic acidosis include:
Nausea and vomiting.
Exhaustion and fatigue.
Fast, deep breathing (respiratory compensation).
Muscle cramps and body aches.

More advanced symptoms may include:
Increasing weakness and drowsiness.
Delirium and confusion.
Ataxia.
Oliguria (low urine output).

Question 23

When would you withhold IV antibiotics when otherwise indicated?

Answer 23

Only when there is a history of anaphylaxis
A rash after taking penicilin is not a contra-indication

Question 24

Above what number NEWS2 score is considered indicative of red flag sepsis?

Answer 24

5 or above

Question 25

What is the maximum dose of fluids you can give to a septic patient?

Answer 25

2000ml

Question 26

What are the most common arrythmias that present with sepsis?

Answer 26

Tachycardia
Atrial fibrillation

Question 27

Why is hyperglycaemia a symptom of sepsis?

Answer 27

Hormones your body makes to fight illness or stress can also cause blood sugar to rise.