Lecture 7 - Sepsis

Question 1

What is the definition of sepsis using numerical values?

Answer 1

Systemic Inflammatory Response Syndrome (SIRS)

2 or more of:
-Temp > 38 or less than 36
-HR > 90
-Resp rate >20/min or PaCO2<32mmHg / 4.3kPa

Question 2

What is considered severe sepsis?

Answer 2

Systemic Inflammatory Response Syndrome + Organ dysfunction

Question 3

What is the new definitions of sepsis?

Answer 3

Life threatening organ dysfunction caused by a dysregulated host response to infection

Question 4

What SOFA score indicates organ dysfunction?

Answer 4

SOFA > 2

Question 5

What do we assume a patients SOFA score is if they are not known not have pre-existing organ dysfunction?

Answer 5

SOFA = 0

Question 6

How can you tell what is considered life-threatening?

Answer 6

NEWS2 score

Not alert
Struggling to breathe
Temp

Question 7

What is considered a dysregulated host response?

Answer 7

Any abnormal reaction to an infection

Question 8

What does the SOFA score describe?

Where is it used?

Answer 8

It attempts to assess how the 6 organ systems are functioning

Higher the score the greater the organ dysfunction

ICU specific

Question 9

In a blood gas, what do each results indicate the function of?

Answer 9

PaO2 = lungs
PaCO2 = lungs
HCO3- = kidneys
Na+, K+, Cl- = less of an indication
Glucose = potentially liver
Lactate = can be a lot of organs

Question 10

What part of a bloood gas is best in detecting sepsis?

Answer 10

Lactate

Question 11

What is the definition of septic shock?

Answer 11

When a. Pateint has sepsis with persisting hypotension requiring vasopressors (adrenaline) to maintain Mean Arterial Pressure > 65mmHg having a serum lactate level > 2mmol/L despetie adequate volume resus

Question 12

How do vasopresors work in septic shock?

Answer 12

Adrenaline
Vasoconstrictor to increase blood pressure increasing the workload of the heart

Question 13

What is the difference between septic and hypovolaemic shock?

Answer 13

Fluid resuscitation should solve hypovolaemic shock

Fluid resus in septic shock would help but not solve since caused by systemic vasodilation driven by cytokines

Question 14

What are the 6 red flag sepsis management steps?

Answer 14

Gives 3 take 3

Ensure senior clinical attends (help)
Oxygen if needed
Obtain IV access and TAKE bloodo
Give IV antibiotics
Give IV fluids
Monitor

Question 15

Go to slide 17, calculate the NEWS2 score of the patient:

Answer 15

NEWS2 = 13

Question 16

How do you assess a potentially septic patient?

Answer 16

A to E

Question 17

What is the A to E assessment method for septic patients?

Answer 17

Airway
Breathing
Cardiovascular
Disability (alert?)
Everything else

Question 18

Looking at case 1 and slide 21, what are the main problems in treating this patient with sepsis?

Answer 18

Hypoxic likely due to pneumonia, give oxygen and Abx

Hypotension + tachycardia:
Give fluids (bolus)
Pressors (adrenaline)

Question 19

What is the give 3 take 3 process for sepsis?

Or BUFALO:

Answer 19

Blood cultures
Urine catheter/output
Fluids
Antibiotics
Lactate levels
Oxygen (if needed)