Flashcards in Pathophysiology and Treatment of Sepsis Deck (42)
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
What does septicaemia mean?
Presence of pathogen in the blood
What does SIRS stand for?
Systemic Inflammatory Response Syndrome
Suspected or proven infection plus systemic inflammatory response (e.g. fever, tachycardia, tachypnea,WBC, altered mental state, hyperglycaemia in absence of diabetes)
What is severe sepsis?
Sepsis plus organ dysfunction (e.g. hypotension, hypoxaemia, oliguria, metabolic acidosis, thrombocytopoenia or obtundation (decreased sensitivity)
What is septic shock?
Severe sepsis plus hypotension, despite fluid resuscitation
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
• Temperature >38oC or <36oC
• PaCO2 <4.3 kPa or ventilated
What physiological changes do SIRS produce?
Widespread endothelial damage with vasodilation
What two conditions are indicators of severe infection?
Septic neutropenia (low neutrophil blood count)
What are some of the clinical presentations (i.e. signs and symptoms) of SIRS?
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
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
List some of the risk factors associated with sepsis.
Severe wounds / burns
Extremes of age
Sepsis has a very wide range of causes; to list a few:
– RT infections
– UT infections
– GI infections
– Pelvic and GU infections
– Line infections
– Skin and soft tissue infections
What type of bacilli are most likely to cause sepsis?
Gram negative cocci
What are some examples of host barrier integrity breach?
Epithelial cell damage
What are some of the factors that can affect signs and symptoms of sepsis?
• Virulence of pathogen
• Portal of entry
• Host susceptibility
• Temporal evolution (when the signs/symptoms manifest themselves)
What does the AVPU Scale assess?
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
Give 5 examples of care bundles.
– Infection control
– Peripheral vascular catheters (PVCs)
– Ventilator-associated pneumonia (VAP) reduction
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
Name an example of a bacterium that contains an endotoxin and list some additional symptoms that can present.
Altered mental state
What does CFU stand for?
Colony forming unit
What is the bioburden?
Number of bacteria living on a surface that has not been sterilised
Name a type of bacterium that can make up a large proportion of the bioburden contributing to sepsis.
With 10^3 CFUs of Salmonella typhimurium, what symptoms can arise?
With 10^5 CFUs of Salmonella typhimurium, what symptoms can arise?
If the bacterium Klebsiella pneumoniae enters renally, what can be some associated symptoms?
If Klebsiella pneumoniae enters via the chest, what can be some associated symptoms?
If Streptococcus pneumoniae infection occurs in a fit adult, what are likely to be the only symptoms?
If Streptococcus pneumoniae infection occurs in an elderly person, what additional symptoms are likely to arise?
Altered mental state
In a case of Neisseria meningitidis infection, what are some early symptoms?
In a case of Neisseria meningitidis infection, what are some later symptoms?
Altered mental state
What is the first line of defence against pathogenic insult?
Innate Immune Response
What does TLR-4 recognise?
List 5 immune molecules/cells/receptors that are actively involved in the innate immune response.
Mannose-binding lectin (MBL)
Toll-like receptors (TLRs)
Nucleotide-binding oligomerisation domain receptors (NLRs)
What are TLRs?
Pattern recognising receptors recognising certain elements of pathogens
Production of inflammatory markers may be initiated. Name 3 types of inflammatory marker.
– Interleukins (ILs)
– Tumour necrosis factor alpha (TNFα)
– Reactive oxygen species (ROS)
What are the 3 major steps in immune action?
What normally compromises the initial response?
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)
What effects do TNF(alpha) and Interleukin-1 (IL-1) have on the body?
Corticosteroid and ACTH (adrenocorticotrophic hormone) release
Release of neutrophils