Flashcards in Clinical Sepsis Deck (14):
On the disease continuum, what is the difference between SIRS and sepsis? What distinguishes severe sepsis?
SIRS is a non-specific clinical response that can be caused by infection as well as trauma, burns and other insults, but sepsis is SIRS with a confirmed infectious process. In severe sepsis there are signs of organ dysfunction in at least one organ. 'Infection suspected and SOFA score 2+'
What distinguishes septic shock from severe sepsis?
Septic shock is severe sepsis with hypotension refractory to adequate volume resuscitation.
What is the mortality in sepsis and in septic shock?
Septic shock 40%
What is the difference between the SOFA score and the qSOFA score?
SOFA required assessment of most systems, with GCS, bilirubin, creatinine, MAP and other tests of organ function. This was too complicated and SOFA scores were missing on many patients, so the quick SOFA (qSOFA) was introduced, and involves measuring just SBP (<100) and respiratory rate (>22) and altered mentation.
What is the toxic component of LPS?
Lipid A (highly preserved)
What is the relationship between endotoxin and Gram-negative sepsis?
Endotoxin directly triggers coagulation and fibrinolytic pathways, and indirectly (endothelial activation) initiates the cytokine cascade producing an inflammatory response. The greater the plasma levels of endotoxin (i.e. LPS), the worse the chances of survival.
What must you measure within 3 hours of identifying a case of potential sepsis?
Some sepsis patients have better survival. What protein can account for this?
What group of pathogens are often implicated in sepsis? What other pathogens can be involved? Which of these has a mortality of 50%?
The ESCAPE pathogens (nosocomial infection).
Can also have viral sepsis, or candida. Candidaemia sepsis has a high mortality if 50%.
Give a short summary of sepsis pathophysiology
Infection, maladaptive response with systemic NFkB->TNFa->vasorelaxation, permeability, hypercoagulation->hypotension and hypovolaemia->shock->mitochondrial dysfunction->hypoxia->multiple organ failure->death.
Microvascular coagulation->tissue injury->organ dysfunction->death.
How do genetic factors influence susceptibility to sepsis?
There can be mediators over expression leading to an inflammatory tendency, such that there is systemic instead of localised inflammation. And thus, instead of regaining homeostasis, you develop sepsis.
Why is there hypotension in sepsis?
There is hypovolaemia due to capillary leak, and there is also reduced vascular time and myocardial depression.
What are the 3 primary features of cardiovascular failure in sepsis?