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Infectious Diseases (4th year) > Sepsis and Septic shock - Part 1 - DONE > Flashcards

Sepsis and Septic shock - Part 1 - DONE Flashcards

1
Q

What is the new definition of sepsis?

A

sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection

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2
Q

What is the definition of organ dysfunction?

A

acute change in total SOFA score consequent to the infection

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3
Q

What is SOFA score (google)?

A

Sepsis-related organ failure assessment score

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4
Q

qSOFA (google/PP):

quickSOFA

A
  • qSOFA is a mortality predictor, NOT a diagnostic test for sepsis
  • A “positive” qSOFA Score (≥2) suggests high risk of poor outcome in patients with suspected infection.
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5
Q

QuickSOFA: 2 of following 3:

A
  • respiratory rate more 22/min
  • altered mental status (GCS less than 15 points)
  • systolic pressure less than 100mmHg
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6
Q

What is the definition of septic shock?

A

septic shock is a subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality than with sepsis alone

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7
Q

What are the risk factors of sepsis?

A
  • Chronic diseases:
    • Acquaried immunodeficiency syndrome
    • Chronic obstructive pulmonary desease
    • Cancers
    • Diabetes
    • Hepatic cirrhosis
    • Immunosupresion
  • Elderly and infant patients
  • Males
  • Blacks
  • Invasive procedures
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8
Q

Etiology of sepsis:

A
  • gram-negative bacteria
  • gram-positive bacteria
  • fungi (e.g. candida)
  • anaerobic bacteria
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9
Q

What are the gram-negative bacteria that causes sepsis?

A
  • pseudomonas
  • escherichia
  • klebsiella
  • acineobacter
  • enterobacter
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10
Q

What are the gram-positive bacteria that causes sepsis?

A
  • staph aureus
  • streptococcus
  • staph epidermidis
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11
Q

What are the source of infection in sepsis?

A
  • pneumonia (most common)
  • intraabdominal infection
  • bacteremia without known origin
  • urine tract infection
  • soft tissue and wound infections
  • blood catheter releated
  • CNS infection
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12
Q

What is the most common source of infection in sepsis?

A

pneumonia

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13
Q

PRP (google):

A

Pattern recognition receptors (PRRs): play a crucial role in the proper function of the innate immune system.

  • pathogen-associated molecular patterns (PAMPs), which are associated with microbial pathogens,
  • and damage-associated molecular patterns (DAMPs), which are associated with components of host’s cells that are released during cell damage or death
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14
Q

Pathophysiology - coagulation abnormalities:

A
  • Sepsis is almost invariably associated with altered coagulation which may lead to disseminated intravascular coagulation (DIC)
  • Impaired anticoagulant mechanism (protein C and antithrombin)
  • Depression of fibrinolytic system
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15
Q

Pathophysiology - Immunosuppression:

A
  • Reduced expression of HLA-DR on myeloid cell
  • Ongoing infections foci despite antimicrobial therapy
  • Enhanced apoptosis of B cells, CD 4 cells, follicular dendritic cells
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16
Q

Pathophysiology - Organ dysfunction:

about oxygen delivery

A

decreased oxygen delivery which leads to:

  • hypotension
  • reduced red cell deformability
  • microvascular thrombosis
17
Q

Pathophysiology - Organ dysfunction:

about vascular endothelium

A
  • dysfunction of vascular endothelium
    • induced by inflammation
    • accompanied by cell deaths
    • loss of barrier integrity
    • subcutaneous and body - cavity edema
18
Q

Pathophysiology - mitochondria:

A
  • mitochondrial damage caused by oxidative stress
  • decreased cellular oxygen use
  • injured mitochondria released alarmins into the extracellular environment (mitochondrial DNA, peptides)
  • activation of neutrophils and further tissue injusry
19
Q

What are alarmins (google):

A

Any endogenous substance that signals tissue and cell damage.

20
Q

What are the clinical manifestation of sepsis?

A
  • Elevated or decreased (often in elderly, immunocompromised and infants) body temperature
  • Shivering, muscle pain
  • General malaise
  • Tachycardia, tachypnea
  • Obtundation or delirium
  • Decreased capillary refill
  • Mottling
  • Jaundice
  • Hypotonia
  • Oliguria
21
Q

Hypotonia def (google):

A

Hypotonia, commonly known as floppy baby syndrome, is a state of low muscle tone

22
Q

Oliguria def (google):

A

Oliguria, the production of abnormally small amounts of urine.

23
Q

Sepsis general variables:

A
  • Fever > 38,3 C or hypothermia < 36 C
  • Heart rate > 90/min
  • Tachypnea
  • Altered mental status
  • Significant edema or positive fluid balance (>20 mL/kg over 24 hr)
  • Hyperglicemia (plasma glucose > 140 mg/dL or 7,7 mmol/l) in the absence of diabetes
24
Q

Sepsis organ dysfunction variables:

A
  • Arterial hypoxemia (PaO2/Fio2< 300)
  • Acute oliguria (urine output< 0,5mL/kg/h for at least two hours despite adequate fluid resuscitation
  • Creatinine increase >0,5 mg/dL or 44,2 umol/L
  • Coagulations abnormalities (INR>1,5 or aPTT >60 s)
  • Ileus (absent bowel sounds)
  • Thrombocytopenia (platelet count < 100000/ul)
  • Hyperbilirubinemia (plasma total bilirubin > 4 mg/dl or 70 umol/L)
25
Q

Sepsis infalammatory variables:

A
  • Leukocytosis (WBC count > 12000/ul
  • Leukopenia (WBC count < 4000 ul/l)
  • Normal WBC count with greater than 10% immature forms
  • Elevated plasma C reactive protein value
  • Elevated plasma procalcitonin value
26
Q

Sepsis tissue perfusion variables:

A
  • Hyperlactatemia (> 2 mmol/L)
  • Decreased capillary refill
  • Mottling
27
Q

Microbiological diagnosis:

A
  • Obtaining appropriate cultures before antimicrobial therapy if such cultures do not cause significant delay (>45 minutes) in the start of antimicrobial administration
  • At least two sets of blood cultures (both aerobic and anaerobic bottles) with at least one drawn percutaneously and one drawn through each vascular access device unless device was recently (<48 hrs) inserted
28
Q

Cultures from other sites considered to be a source of infection:

A
  • Urine
  • Cerebrospinal fluid
  • Wounds
  • Respiratory secretions
  • Other body fluids
29
Q

Microbial diagnosis - Intravascular catheter (in place > 48 hours):

A
  • at least one blood culture set should be obtained from the catheter
  • along with simultaneous peripheral blood cultures
30
Q

Suspicion of invasive candidiasis:

A
  • 1,3 β-d-glucan
  • mannan
  • Anti-mannan antibody assays
31
Q

Imaging studies

A
  • CT, ultrasound, X-ray

- Identifications of potential source of infection that requires removal of a foreign body or drainage

Infectious Diseases (4th year) (19 decks)

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