Sepsis and Septic Shock

Question 1

Define sepsis

(according to the Sepsis-3 guidelines)

Answer 1

Life-threatening organ dysfunction caused by dysregulated host response to infection

Question 2

Define septic shock

(according to the Sepsis-3 guidelines)

Answer 2

Sepsis with persisting hypotension requiring vasopressors to maintain MAP >65mmHg and haging a serium lactate of >2mmol/l despite adequate volume resuscitation

Question 3

What is qSOFA?

Answer 3

Quick Sequential (sepsis-related) Organ Failure Assessment Score

A screening tool used to identify patients with suspected infection who are likely to have a prolonged ICU stay or die in hospital

Question 4

What are the components of qSOFA?

Answer 4

• Hypotention: systolic BP <100mmHg
• Altered mental status
• Tachypnoea: RR >22 breaths/min

Score of 2 or more suggests a greater risk of poor outcome

Question 5

What are the body’s defences against sepsis? (3)

Answer 5

• Physical barrier - skin, mucosa, epithelial lining
• Innate immune system - IgA in GI tract, dendritic cells, macrophages
• Adaptive immune system - lymphocytes and immunoglobulins

Question 6

What are the three phases in the pathogenesis of sepsis?

Answer 6

1. Release of bacterial toxins (e.g. lipopolysaccharide (LPS) and lipoteichoic acid (LTA))
2. Release of mediators (Th1 - pro-inflammatory, Th2 - compensatory anti-inflammatory)
3. Effects of specific excessive mediators (too many pro-inflammatory mediators = septic shock, too many anti-inflammatory mediators = immunoparalysis)

Question 7

What three factors do the clinical features of sepsis depend on?

Answer 7

• Host
• Organism
• Environment

Question 8

What are the general features of sepsis? (6)

Answer 8

• Fever >38 oC
• Hypothermia <36 oC
• Tachycardia >90 bpm
• Tachypnoea >20/min
• Altered mental status
• Hyperglycaemia >8mmol/l in the absence of diabetes

Question 9

What are some of the inflammatory variables in sepsis? (3)

Answer 9

• Low, high or normal white cell count
• High C reactive protein
• High procalcitonin

Question 10

What are some haemodynamic variables in sepsis? (2)

Answer 10

• Arterial hypotension

- SvO2 >70%

Question 11

What are some organ dysfunction variables in sepsis? (7)

Answer 11

• Arterial hypoxaemia
• Oliguria
• Creatinine increase
• Coagulation abnormalities
• Ileus
• Thrombocytopenia
• Hyperbilirubinaemia

Question 12

What are some tissue perfusion variables in sepsis? (2)

Answer 12

• High lactate - v important

- Skin mottling and reduced capillary perfusion

Question 13

What host factors can have an effect on sepsis presentation? (4)

Answer 13

• Age
• Co-morbidities
• Immunosuppression
• Previous surgery

Question 14

What is Sepsis 6?

Answer 14

The steps in the management of sepsis

Question 15

What are the components of Sepsis 6?

take 3, give 3

Answer 15

Take 3:

• Blood cultures
• Blood lactate
• Measure urine output

Give 3:

• Aim oxygen sats 94.98%
• IV antibiotics
• IV fluid challenge

Question 16

Why is it important to measure blood lactate in a septic patient?

Answer 16

It is a marker of generalised hypoperfusion - poorer prognosis