Sepsis

Question 1

What is sepsis?

Answer 1

where the body launches a large immune response to an infection causing systemic inflammation and organ dysfunction

Question 2

Give an overview of the pathophysiology of sepsis:

Answer 2

1) in the face of overwhelming infection, immune cells stimulate the immune system using cytokines
2) some of these cytokines cause the endothelial lining of blood vessels to become more permeable, resulting in oedema and reduced intravascular volume
3) some cytokines activate the coagulation system, leading to the formation of thrombi

Question 3

Why is thrombocytopenia a feature of sepsis?

Answer 3

the immune system activates the clotting system which results in thrombus formation and the consumption of platelets

Question 4

What is the difference between sepsis and septicaemia?

Answer 4

Sepsis is often confused with septicaemia, which refers to microbiological invasion of the bloodstream. Sepsis is a separate clinical entity that can occur in response to any infection, with or without septicaemia.

Question 5

What are the symptoms of an excessive cytokine realease?

Answer 5

1. Vasodilation
2. Increased vascular permeability
3. Inappropriate activation of the coagulation cascade
4. Immune system impairment

Question 6

What is the name of the disease where the immune system stimulates thrombus formation, causing thrombocytopenia and uncontrolled bleeding?

Answer 6

disseminated intravascular coagulopathy (DIC)

Question 7

Why is lactate raised in sepsis?

Answer 7

tissues have inadequate blood supplies leading to anaerobic respiration

Question 8

What is septic shock?

Answer 8

where there is a large drop in arterial blood pressure in sepsis, despite fluid resuscitation

Question 9

Give the 2 diagnostic features of septic shock:

Answer 9

1) blood pressure below 65mmHg despite fluid resuscitation
2) raised serum lactate (above 2mmol/L

Question 10

What specific drug type is used to treat septic shock?

Answer 10

vasopressors such as noradrenaline

Question 11

What is the name of the criteria used to check for sepsis-related organ failure?

Answer 11

sepsis-related organ failure assessment (SOFA)

Question 12

Give 8 characteristics checked for in the sepsis-related organ failure assessment:

Answer 12

1) hypoxia
2) increased oxygen requirement
3) requiring ventilation
4) thrombocytopenia
5) reduced GCS
6) raised bilirubin
7) raised BP
8) raised creatinine

Question 13

Give 6 risk factors for sepsis?

Answer 13

1) chemo, immunosuppressant or steroid use
2) very old (over 75) or very young (under 1)
3) pregnancy or childbirth
4) chronic conditions e.g. COPD or diabetes
5) surgery, recent trauma, burns
6) indwelling devices (catheters or central lines)

Question 14

Give 7 clinical presentations associated with sepsis:

Answer 14

1) tachypnoea
2) reduce urine output
3) mottled skin
4) cyanosis
5) arrhythmias (new onset AF)
6) signs of potential sources (cellulitis, cough, infected wound)
7) confusion or drowsiness (particularly in elderly)

Question 15

What scoring system is used to monitor the risk of deterioration and sepsis?

Answer 15

NEWS2

Question 16

What 6 parameters are monitored in NEWS2 scoring?

Answer 16

1) temperature
2) heart rate
3) respiratory rate
4) oxygen saturation
5) blood pressure
6) consciousness

Question 17

List the 8 blood tests that should be ordered to investigate sepsis:

Answer 17

1) FBC
2) U&Es
3) LFTs
4) CRP
5) blood glucose
6) clotting
7) blood cultures
8) VBG

Question 18

In what time frame should a patient presenting with suspected sepsis be assessed and commenced on treatment?

Answer 18

1 hour

Question 19

Give the sepsis six (BUFALO):

Answer 19

1) blood cultures
2) urine output
3) fluids
4) antibiotics (empiric broad spectrum)
5) lactate
6) oxygen

Question 20

What specific signs relating to underlying causes may be found in septic patient’s?

Answer 20

Respiratory: coarse respiratory crepitations, bronchial breathing
Urinary: suprapubic tenderness, flank tenderness
Gastrointestinal: abdominal distension, abdominal guarding/rigidity
Skin / soft tissue: skin redness (erythema) / heat (calor)
Central nervous system: reduced GCS, nuchal rigidity, papilloedema, positive Kernig’s sign
Cardiovascular: new murmur, splinter haemorrhages

Question 21

What 4 beside investigations are used in suspected sepsis patients?

Answer 21

1. VBG - assess lactate level
2. Capillary blood glucose - rule out hypo and hyperglycaemia
3. Electrocardiogram - rule out arrhythmias
4. Urine dipstick - assess for the presence of a UTI

Question 22

Give the definition of neutropenic sepsis:

Answer 22

someone in sepsis with a neutrophil count below 1x10^9/L

Question 23

Name 9 medications (and their indications) which can cause neutropenia:

Answer 23

1) chemotherapy
2) clozapine (schizophrenia)
3) hydroxychloroquine (RA)
4) methotrexate (RA)
5) sulfasalazine (RA)
6) carbimazole (hyperthyroidism)
7) quinine (malaria)
8) infliximab (multiple autoimmune conditions)
9) rituximab (multiple autoimmune conditions)

Question 24

What is the threshold used for suspecting neutropenic sepsis in patients taking neutropenia-causing drugs?

Answer 24

temperature above 38 degrees C

Question 25

What is the first line broad spectrum antibiotic used for neutropenic sepsis?

Answer 25

piperacillin with tazobactam