Define sepsis. (3)
A dysregulated host response to infection that causes life threatening organ dysfunction.
Describe 4 features of a seriously ill patient that would make you more likely to suspect sepsis. (4)
Age < 1 year.
Impaired immunity
Recent surgery / trauma / skin breaks
Indwelling lines / catheters / devices.
Describe the sepsis 6 for paediatric patients. (7)
Give high flow oxygen Take blood cultures (get IV or IO access) Give IV antibiotics CONSIDER IV fluids based on lactate Involve senior clinicians early Consider inotropic support
Give six characteristics of a child that would cause minor concern, and result in an EWS score of 1. (6)
Audible wheeze Mild costal recession Long term steroids Diabetes Ex-premie Any syndromic condition
Give four characteristics of a child that would cause major concern, and result in an EWS score of 2. (4)
Stridor
Severe costal recession
Oncology patient
Congenital heart disease
Name three physical barriers to infection. (3)
Skin
Mucous membranes
Bronchial cilia
Name three physiological barriers to infection. (3)
Diarrhoea
Vomiting
Coughing
Name two chemical barriers to infection. (2)
Low pH (vagina, stomach) Antimicrobial agents
Name three features of normal flora that help to fight infection. (3)
Competition for nutrition
Production of antimicrobials
Synthesis of vitamins
Staph aureus
Gram positive cocci
Staph epidermis
Gram positive cocci
Strep pneumoniae
Gram positive cocci
Strep pyogenes
Gram positive cocci
Enterococci faecalis
Gram positive cocci
Gram positive cocci found normally on the skin, that can also be highly penicillin resistant.
Staph aureus
A coagulate negative cocci that is gram positive.
Staph epidermis
Alpha haemolytic cocci that is gram positive.
Strep pneumoniae
Beta haemolytic cocci that is gram positive.
Strep pyogenes
Listeria monocytogenes
Gram positive bacilli
Bacillus antracis
Gram positive bacilli
Clostridium difficile
Gram positive bacilli
Gram positive bacilli that can cause listeriosis.
Listeria monocytogenes.
Gram positive bacilli that is developed from cattle, also known as anthrax.
Bacillus antracis
Gram positive bacilli that is spore-forming.
Clostridium difficile
Two antibiotic classes used to treat gram positive cocci.
Penicillins
Carbopenems
Two antibiotic classes used to treat gram negative cocci.
Cephalosporin
Quinolone
Neisseria meningitidis
Gram negative cocci
Neisseria gonorrhoea
Gram negative cocci
Acinetobacter baumannii
Gram negative cocci
Gram negative cocci that can cause meningitis.
Neisseria meningitidis
Gram negative cocci that can cause septic arthritis and gonorrhoea.
Neisseria gonorrhoea
Gram negative cocci that is a common cause of hospital acquired pneumonia in the immunosuppressed.
Acinetobacter baumannii
Escherichia coli
Gram negative bacilli
Salmonella typhi
Gram negative bacilli
Pseudomonas aeruginosa
Gram negative bacilli
Haemophilus influenzae
Gram negative bacilli
Gram negative bacilli that produces vitamin K in the small intestine, but can cause food poisoning.
Escherichia Coli.
Gram negative bacilli that causes typhoid fever.
Salmonella typhi
Gram negative bacilli that commonly causes ITU sepsis as an opportunistic pathogen that is naturally antibiotically resistant.
Pseudomonas aeruginosa
Gram negative bacilli that causes pneumonia and is vaccinated against.
Haemophilus influenzae
Mycobacterium tuberculosis
A bacilli that can appear as gram negative or positive.
A bacilli that can appear as either gram negative or gram positive
Mycobacterium tuberculosis
A unicellular fungi that causes thrush.
Candida albicans
Candida albicans
A yeast that causes thrush.
A Protozoa that causes malaria.
Plasmodium falciparum
Plasmodium falciparum
A Protozoa that causes malaria
Aspergillus
A species of mould
Giardia lamblia
A Protozoa that can cause diarrhoea
Describe the sepsis 6.
Give empiric IV antibiotics Give high flow oxygen Give IV fluid resuscitation Take blood for culture Take serum lactate Take accurate urine output measurement
Name the five classes of beta lactams
Penicillin Beta lactamase inhibitors Cephalosporins Carbapenems Monobactams
Name three penicillins
Penicillin
Amoxicillin
Flucloxicillin
Amoxicillin
A penicillin
Flucloxicllin
A penicillin
Co-amoxiclav
A beta lactamase inhibitor
Name three beta lactamase inhibitors
Co-amoxiclav
Piperacillin
Tazobactam
Piperacillin
A beta lactamase inhibitor
Tazobactam
A beta lactamase inhibitor
Cephalosporin
Ceftriaxone
Ceftriaxone
A cephalosporin with good action in the CSF
Carbapenem
Meropenem
Meropenem
Carbapenem that is the UHL first choice in sepsis
Tetracycline
Doxycycline
Doxycycline
A tetracycline used in penicillin allergy and chlamydia.
Glycopeptides (2)
Vancomycin
Teicoplanin
Vancomycin
A glycopeptide good for C. Diff.
Teicoplanin
A glycopeptide used for C. Diff.
Aminoglycoside
Gentamicin
Gentamicin
Aminoglycoside reserves for G neg sepsis due to its nephrotoxicity
Macrolides
Erythromycin
Erythromycin
A macrolide with good intracellular penetration
Quinolone
Ciprofloxacin
Ciprofloxacin
Quinolone that inhibits DNA gyrase with a high C. Diff risk
Trimethoprim MoA
Inhibition of folic acid synthesis in UTIs
Co-trimoxazole
Trimethoprim + sulphamethoxazole used in PCP and MRSA
Trimethoprim + sulphamethoxazole used in PCP and MRSA
Co-trimoxazole
Azoles
Inhibit cell membrane synthesis to act as an antifungal
Metronidazole
Anaerobic bacteria and Protozoa action