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PY6010 > Introduction to Sepsis > Flashcards

Introduction to Sepsis Flashcards

1
Q

What is sepsis?

A

It is a syndrome due to organ dysfunction from a dysregulated response to an infection (overreactive immune system)

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2
Q

What is septic shock?

A

It is circulatory, cellular and metabolic abnormalities occurring with a greater risk of death

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3
Q

What does sepsis induce?

A

It induces an excess inflammatory response, forming side effects such as hypotension, fever, tachycardia, hypoxia, and organ failure.

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4
Q

What is immune paralysis?

A

It is the inability of the immune system to recover from a pathogen, even with antibiotics due to the shutting down of phagocytes/neutrophils (leading to a hyporeactive immune response)

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5
Q

Why do blood vessels dilate in sepsis?

A

Vessels have increased permeability and become leaky, so water and proteins are lost e.g. bradykinin, NO, histamine, and interleukins.

These all induce vasodilation.

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6
Q

How does hypercoagulability of blood occur in sepsis?

A

Platelet-fibrin clots are formed from activated platelet/clotting factors.

Tissue factor is also released from endothelial cells, which triggers the clotting cascade.

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7
Q

What effects occur due to sepsis in the brain?

A
  1. Low BP due to reduced circulation
  2. Altered mental state due to cytokines/inflammatory mediators
  3. Impaired cognition
  4. Mini-infarctions in the brain
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8
Q

What effects occur due to sepsis in the heart?

A
  1. Reduced O2 to myocytes
  2. Reduced cardiac output, perfusion of organs and force of contraction
  3. Small blood vessels in the body constrict to protect vital organs
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9
Q

What is septic cardiomyopathy?

A

It is a reversible myocardial dysfunction with acute onset.

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10
Q

What effects occur due to sepsis in the lungs?

A
  1. Fluid/proteins leak into lungs affecting O2 exchange
  2. Reduced organ perfusion
  3. Increased respiratory rate, but poor blood flow
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11
Q

What effects occur due to sepsis in the kidneys?

A
  1. Low urine output
  2. Reduced GFR and renal perfusion
  3. Acute kidney injury
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12
Q

What effects occur due to sepsis in the liver?

A
  1. Reduced perfusion and increased liver enzymes
  2. Clotting factor production reduced = risk of bleeding
  3. Blood glucose rises due to increased gluconeogenesis & glycogenolysis.
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13
Q

Why are there high mortality rates for sepsis?

A
  1. Difficult to diagnose (e.g. due to other co-morbid diseases)
  2. Appropriate action not taken quickly enough
  3. Rapid deterioration can occur with organ failure
  4. Symptoms can be common/non-specific
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14
Q

What are some risk factors of sepsis?

A
  1. Impaired community (children/elderly)
  2. Recent surgery
  3. Recent cuts/burns/skin infections
  4. IV drug misuse
  5. Genetics
  6. Given birth/miscarriage/abortion
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15
Q

Which types of pathogens can cause sepsis?

A

Gram +VE and -VE bacteria, and fungal infections.

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16
Q

Which common pathogens in adults can cause sepsis?

A
  1. E.coli
  2. Staph/strep strains
  3. Pseudomonas aeruginosa
17
Q

Which common pathogens in children cause sepsis?

A
  1. Strep/staph strains
  2. Pseudomonas meningitis
  3. Group B streps in neonates
18
Q

What should children with sepsis be checked for?

A
  1. Fits/convulsions
  2. Fast breathing
  3. Looking blue/pale
  4. Abnormally cold to the touch
  5. Lethargic/difficult to wake up
19
Q

What does the acronym SEPSIS stand for (used to diagnose sepsis in a person)?

A 
S: slurred speech/confusion
E: extreme shivering/muscle pain
P: passing no urine in a day 
S: severe breathlessness 
I: it feels like you're going to die 
S: skin discoloured or mottled
20
Q

What is the NEWS scoring system used for, and what does it consist of?

A

It is a scoring system used to detect deteriorating patients. It includes:

  1. Resp. rate
  2. O2 saturation
  3. BP
  4. Pulse
  5. New changes to levels of consciousness
  6. Temp.
21
Q

What is the sepsis 6, and when should it be performed?

A

It is 6 strategies used to reduce the mortality of patients with sepsis
Must be performed within 1 hour of diagnosis.

  1. IV antibiotics within 1h
  2. Consider IV fluid bolus
  3. Provide oxygen
  4. Take cultures before giving antimicrobials
  5. Take bloods
  6. Monitor urine output
22
Q

Which antibiotic is often given in a septic patient?

A

Usually a broad spectrum antibiotic + combination if the source of infection is known.

23
Q

Which antibiotic is given if the source of infection is unknown?

A

Co-amoxiclav and gentamicin

24
Q

Which antibiotic is given in adult neutropenic sepsis, with unknown origin?

A

Piperacillin with tazobactam (also called tazocin) + amikacin

25
Q

What is the pharmacists role in treating a septic patient?

A
  1. Ensure antibiotics are given on time
  2. Check allergies
  3. Correct empirical choice of antibiotic according to guidelines
  4. Optimise antibiotic dose based on e.g. weight, liver/renal function
  5. Making sure not to underdose
  6. Right administration
  7. Consider extended or continuous infusion
  8. Antibiotic stewardship

PY6010 (23 decks)

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