Pathophysiology and Treatment of Sepsis Flashcards Preview

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Flashcards in Pathophysiology and Treatment of Sepsis Deck (42)
1

What are the Sepsis Six?

A list of guidelines set out in case of a sepsis emergency:

• Administer high flow oxygen
• Take blood cultures
• Give broad spectrum antibiotics
• Give intravenous fluid challenges
• Measure serum lactate and haemoglobin
• Measure accurate hourly urine output

BUFALO

2

What does septicaemia mean?

Presence of pathogen in the blood

3

What does SIRS stand for?

Systemic Inflammatory Response Syndrome

4

Define sepsis.

Suspected or proven infection plus systemic inflammatory response (e.g. fever, tachycardia, tachypnea,􏰃WBC, altered mental state, hyperglycaemia in absence of diabetes)

5

What is severe sepsis?

Sepsis plus organ dysfunction (e.g. hypotension, hypoxaemia, oliguria, metabolic acidosis, thrombocytopoenia or obtundation (decreased sensitivity)

6

What is septic shock?

Severe sepsis plus hypotension, despite fluid resuscitation

7

SIRS is defined by the presence of two or more factors. List the 5 factors that make up the potentials.

• Respiratory rate >20/min
• Heart rate >90/min
• WBC>12x109/Lor<4x109/L
• Temperature >38oC or <36oC
• PaCO2 <4.3 kPa or ventilated

8

What physiological changes do SIRS produce?

Widespread endothelial damage with vasodilation
Arterio-venous shunting
Microvascular occlusion
Capillary leak
Tissue oedema

9

What two conditions are indicators of severe infection?

Hypothermia
Septic neutropenia (low neutrophil blood count)

10

What are some of the clinical presentations (i.e. signs and symptoms) of SIRS?

Warm peripheries
Bounding pulses and features of high cardiac output
Peripheral vasodilation leading to 􏰄diastolic BP
Decreased afterload, therefore stroke volume and systolic BP is maintained
Large difference between DBP and SBP e.g. 115/42mmHg

11

What clinical presentations can arise as sepsis develops and advances?

Systolic BP decreases and the peripheries become cool due to hypovolaemia associated with capillary leak

12

List some of the risk factors associated with sepsis.

Immunosuppression
Asplenic patients
Diabetics
Pregnancy
Cancer patients
Prosthetic devices
Mechanical ventilation
Severe wounds / burns
Post-surgery
Extremes of age

13

Sepsis has a very wide range of causes; to list a few:

– RT infections
– UT infections
– Meningitis
– GI infections
– Pelvic and GU infections
– Line infections
– Skin and soft tissue infections

14

What type of bacilli are most likely to cause sepsis?

Gram negative cocci

15

What are some examples of host barrier integrity breach?

Skin
Mucous membranes
Catheters
Wounds
Burns
Thorn pricks
Insect bites
Epithelial cell damage

16

What are some of the factors that can affect signs and symptoms of sepsis?

• Virulence of pathogen
• Bioburden
• Portal of entry
• Host susceptibility
• Temporal evolution (when the signs/symptoms manifest themselves)

17

What does the AVPU Scale assess?

Alert
Voice
Pain
Unresponsiveness

18

What are care bundles and what is their function?

Structured way of improving processes of care
Straightforward set of practices
When performed collectively, reliably and continuously, improve patient outcomes

19

Give 5 examples of care bundles.

– Infection control
– Peripheral vascular catheters (PVCs)
– Stroke
– Ventilator-associated pneumonia (VAP) reduction
– Sepsis

20

What is the difference between exotoxin and endotoxin?

Exotoxin is a toxic substance secreted by the bacterium
Endotoxin is part of the bacterium that is toxic, e.g. LPS in the bacterium cell wall

21

Name an example of a bacterium that contains an endotoxin and list some additional symptoms that can present.

Streptococcus pyogenes

Cellulitis
Toxic shock
Hypotension
Altered mental state

22

What does CFU stand for?

Colony forming unit

23

What is the bioburden?

Number of bacteria living on a surface that has not been sterilised

24

Name a type of bacterium that can make up a large proportion of the bioburden contributing to sepsis.

Salmonella typhimurium

25

With 10^3 CFUs of Salmonella typhimurium, what symptoms can arise?

Gurgling stomach
Loose stools

26

With 10^5 CFUs of Salmonella typhimurium, what symptoms can arise?

Haemorrhagic colitis
Fever
Abdominal pain

27

If the bacterium Klebsiella pneumoniae enters renally, what can be some associated symptoms?

Tachycardia
Fever

28

If Klebsiella pneumoniae enters via the chest, what can be some associated symptoms?

Tachycardia
Fever
Hypotension

29

If Streptococcus pneumoniae infection occurs in a fit adult, what are likely to be the only symptoms?

Pneumonia
Fever

30

If Streptococcus pneumoniae infection occurs in an elderly person, what additional symptoms are likely to arise?

Fever
Pneumonia
Physical unsteadiness
Confusion
Altered mental state

31

In a case of Neisseria meningitidis infection, what are some early symptoms?

Fever
Malaise
Headache
Myalgia
Arthralgia

32

In a case of Neisseria meningitidis infection, what are some later symptoms?

Septic shock
Altered mental state
Hypotension

33

What is the first line of defence against pathogenic insult?

Innate Immune Response

34

What does TLR-4 recognise?

LPS

35

List 5 immune molecules/cells/receptors that are actively involved in the innate immune response.

Complement cascade
Mannose-binding lectin (MBL)
Phagocytes
Toll-like receptors (TLRs)
Nucleotide-binding oligomerisation domain receptors (NLRs)

36

What are TLRs?

Pattern recognising receptors recognising certain elements of pathogens

37

Production of inflammatory markers may be initiated. Name 3 types of inflammatory marker.

– Interleukins (ILs)
– Tumour necrosis factor alpha (TNFα)
– Reactive oxygen species (ROS)

38

What are the 3 major steps in immune action?

Access
Recognition
Response

39

What normally compromises the initial response?

Inflammation

40

List some causiative mechanisms and their subsequent responses.

Increase in glucose
Increase in temperature
Low O2 levels and low blood flow
Decrease in fibrinolysis
Tries to vasoconstrict…
But NO and endotoxins try to vasodilate…
Endothelium starts to break down

Increased (but not uncontrolled clotting of blood)

41

What effects do TNF(alpha) and Interleukin-1 (IL-1) have on the body?

Fever
Hypotension
Increased HR
Corticosteroid and ACTH (adrenocorticotrophic hormone) release
Release of neutrophils

42

What effects do TNF(alpha) and Interleukin-1 (IL-1) have on the CVS specifically?

• Generalised vasodilation (NO.)
• Increased vascular permeability (activated leukocytes) (albumin moves out into interstitium, thus taking fluid with it and decreasing blood volume))
• Intravascular fluid loss
• Myocardial depression (tissue hypoxia)
• Circulatory shock

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