Sepsis

Question 1

What are the 4 stages of sepsis?

Answer 1

SIRS-systemic inflammatory response syndrome
Sepsis
Severe sepsis
Septic shock

Question 2

Define sepsis

Answer 2

SIRS+infection

Systemic illness caused by microbial invasion of normally sterile parts of the body.

Question 3

Define severe sepsis

Answer 3

Sepsis with organ dysfunction

Question 4

What is septic shock?

Answer 4

Sepsis with sustained hypotension (low BP) not improved by fluids, vasopressors required to maintain MAP>65mmHg and serum lactate >2mmol.

Question 5

What are the qSOFA criteria?

Answer 5

2 or more needed of:
Hypotension (systolic BP< 100mmHg)
Altered mental state
Tachypnea RR>22/min

Question 6

What is an antimicrobial delay and what does it mean?

Answer 6

This is the time it takes to give the patient antibiotics, the longer the antimicrobial delay the worse the prognosis.
Every hour increases mortality by 7.6%

Question 7

How does sepsis occur?

Answer 7

Pathogens breach the host barrier (either physically or immunologically) and enter the blood stream. Any patient is then not able to clear the infection and there is an uncontrolled response.
1st bacterial toxins are released which causes inflammation, then mediators released then specific excessive mediators are released causing anti-inflammatory immunosuppressive phase.

Question 8

What are the potential features of sepsis?

Answer 8

Fever (>38) or hypothermia (<36)
tachycardia (>90bpm)
tachypnoea (>22/min)
altered mental state
hyperglycaemia (>8mmol/l) in absence of diabetes)
jaundice
increase creatinine
high or low wcc (>12000 or <4000), high CPR, high procalcitonin
Hyperbilirubinemia
high lactate

Question 9

What is the treatment of sepsis?

Answer 9

IV Antibiotics
IV fluids
Oxygen (aim for 94-98%)
Take blood cultures, blood lactate and measure urine output.

Question 10

What 3 do you give in sepsis treatment?

Answer 10

IV fluids
IV antibiotics
Oxygen (aim for 94-98%)

Question 11

What 3 things do you take in Sepsis treatment? why are they taken?

Answer 11

Blood cultures- make microbial diagnosis
Blood lactate- marker of generalised hypoperfusion/severe sepsis/poorer prognosis
Measure urine output- low urine output is marker or renal dysfunction

Question 12

A definition of sepsis.

Answer 12

Sepsis - a life-threatening organ dysfunction caused by dysregulated host response to infection.

Question 13

What are the effects of pro-inflammatory specific excess mediators?

Answer 13

Promote adhesion of endothelial cells and leukocytes
Release of arachidonic acid metabolites
Complement activation
Vasodilation of blood vessels by NO
Increase coagulation by release of tissue factors and membrane coagulants
Hyperthermia

Question 14

What do anti-inflammatory specific excessive mediators cause?

Answer 14

Inhibit TNF-alpha so reduce temp
Augment acute phase reaction
Inhibit activation of coagulation system
Provide negative feedback mechanisms to pro-inflammatory mediators