Acute Sepsis

Question 1

What are the 6 key signs of sepsis?

Answer 1

Slurred speech, 
extreme shiver/muscle pain, 
passing no urine in a day, 
severe breathlessness, 
‘feel like I might die’, 
skin mottled

Question 2

On examination what is found in a patient with sepsis?

Answer 2

High temp, 
high HR, 
low BP, 
high resp rate, 
non-blanching rash

Question 3

Define sepsis

Answer 3

Life-threatening organ dysfunction due to dysregulated host response to infection

Question 4

Define septic shock

Answer 4

Persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation

Question 5

Define bacteraemia

Answer 5

Presence of bacteria in the blood (+/- clinical features)

Question 6

What chart is used to recognise sepsis and how is this achieved?

Answer 6

Early warning score (EWS) = basic observations (RR, HR, temp, BP)

Question 7

What are the red flags of sepsis?

Answer 7

High RR, low BP, unresponsive

Question 8

What is in the sepsis 6 bundle and when should this be used?

Answer 8

Giving: Oxygen, IV Abx, fluid challenge.

Taking: blood cultures, lactate, urine output

all needs to be completes with 1 hour of recognising red flag sepsis

Question 9

What urgent investigations should be sent when querying sepsis and why?

Answer 9

FBC = WBC raised, platelets raised.
U+Es = measures kidney function, creatinine expulsion.
PCR/blood culture/gram stain = identify MO.
Blood sugar, sepsis effects sugar met.
LFT = clotting factors effects.
CRP = raised with inflam.
BG = measure O2/CO2 to assess lung function.

Question 10

What factors determine if the host is damaged by infection?

Answer 10

Infectivity: If the MO can attach

virulence: toxin production, interaction with the host defences, inflam

Question 11

From the MO point of view what is the benefit of the polysaccharide capsule?

Answer 11

Promotes adherence, prevents phagocytosis

Question 12

What is the aim of local cytokines vs systemic cytokines?

Answer 12

Local = stim inflam to promote wound repair, recruit phagocytes.

Systemic = stim GF, macrophages, platelets, control infect

Question 13

Cytokines prod during sepsis have what effect on coagulation?

Answer 13

Initiate prod of thrombin, inhibit fibrinolysis = promote coag = MICROVASCULAR thrombosis = organ ischaemia = organ failure = body prioritises blood flow to vital organs = further compromised blood flow to limbs

Question 14

Why is a drop in BP seen in sepsis?

Answer 14

Infection = inflam = vasodilation of arterial vessels = drop in BP

Question 15

What is the treatment for sepsis?

Answer 15

Physiological restoration = ITU, sepsis six, regular monitoring/reassessment.

Antimicrobials = appropriate meds, correct dose, penetrance

Question 16

Outline the life-threatening complications of sepsis

Answer 16

Irreversible hypotension, 
resp failure, 
renal failure, 
raised intracranial pressure, 
necrosis