Sepsis & Hospital Acquired Infection

Question 1

What is sepsis?

Answer 1

Large immune response to an infection that causes systemic inflammation and life-threstrning organ dysfunction

Question 2

What is organ dysfunction?

Answer 2

Organ dysfunction can be identified as an acute change in total SOFA (sequential organ failure assessment) score > 2 points consequent to the infection

Question 3

What does the SOFA questionnaire identify?

Answer 3

Identifies patients with suspected infection who are likely to have a prolonged ICU stay or die in hospital

Question 4

What factors does SOFAq take into consideration?

Answer 4

Hypotension systolic BP <100 mmHg

Altered mental state

Tachypnoea RR >22/min

Question 5

What SOFA score suggests a poor outcome?

Answer 5

>2

Question 6

What are the general features of sepsis?

Answer 6

Fever > 38C presenting as

• Chills
• Rigors
• Flushes
• Cold sweats
• Night sweats

Tachycardia

Tachypnoea

Hypotensive

Altered mental status, especially in the elderly

Hyperglycaemia >8mmol/l in the absence of diabetes

Question 7

What is sepsis 6?

Answer 7

Take 3, Give 3

Blood cultures

Blood lactate

Measure urine output, marker of renal dysfunction

Oxygen aim sats 94-98%

IV antibiotics

IV fluid challenge 30ml/kg

Question 8

What antibiotics are given in sepsis?

Answer 8

AGM

Amoxicillin

Gentamicin

Metronidazole

Question 9

What factors suggest HDU referral requirement?

Answer 9

Low BP responsive to fluids

Lactate > 2 despite fluid resuscitation

Elevated creatinine

Oliguria

Liver dysfunction

Bilateral infiltrates, hypoxaemia

Question 10

What factors suggest ITU referral?

Answer 10

Septic shock

Multi-organ failure

Requires sedation, intubation and ventilation

Question 11

What is MRSA?

Answer 11

Methicillin-resistant Staphylococcus aureus, a common hospital aquired infection

Question 12

What antibiotics are used in MRSA infection?

Answer 12

Vancomycin, first line

Linezolid, second line

Question 13

What is the first line antibiotic for staph aureus infection?

Answer 13

Flucloxacillin

Question 14

What causes C.Difficile infection?

Answer 14

Cephalosporins

Co-Amoxiclav

Clindamycin

Ciprofloxacin

Question 15

How is C.Difficile infection managed?

Answer 15

Reduction in broad spectrum antibiotic prescribing, avoiding the 4 C’s

Isolate symptomatic patients

Wash hands between patients as spores resist alcohol rubs

Oral metronidazole if no severity markers

Oral vancomycin if 2 or more severity markers or if does not respond to metronidazole

Question 16

What organism is the most common cause of central line infections?

Answer 16

Staphylococcus epidermidis

Question 17

How is anaphylaxis managed?

Answer 17

Adrenalin

Administer oxygen and manage airway

IV fluid challenge

Chlorphenamine and hydrocortisone

Attach patient to monitoring

Question 18

How can anaphylaxis be officially diagnosed?

Answer 18

Serum levels of mast cell tryptase

Question 19

What is the adrenalin dose for children under 6?

Answer 19

150 micrograms of 1:1000

Question 20

What is the adrenalin dose for children 6-12?

Answer 20

300 micrograms of 1:000

Question 21

What is the adrenalin dose for children over 12 and adults?

Answer 21

500 micrograms 1:000

Question 22

Anaphylaxis can occur as a bi-phasic reaction. Who is most at risk of this and when does it occur?

Answer 22

4-6 hours after initial reaction

Young children

Question 23

How is influenza managed?

Answer 23

Oral oseltamivir