Sepsis

Question 1

SOFA?

Answer 1

Sequential (Sepsis-related) 
Organ 
Failure 
Assessment 
score 

sepsis- acute change >2

Question 2

qSOFA

Answer 2

Quick SOFA

• RR >22
• altered mentation
• BP <100mmHg

Question 3

Septic shock is?

Answer 3

sepsis + hypotension

Question 4

Sepsis 6?

Answer 4

Give 3 and take 3

give:
1. O2 (aim for 94-98% sats)
2. IV A/Bs
3. Fluid challenge

take:

1. Blood Lactate - marker of generalised hypo perfusion (severe sepsis)
2. Measure Urine output (renal dysfunction)
3. Blood culture

Question 5

Physiology of sepsis

Answer 5

1. Bacterial invasion - ENDOTOXIN: binds to macrophage
2. release of CYTOKINES
3. initial increase in PRO-inflammatory mediators: COMPLEMENT activation, vasodilation (septic shock)
4. compensatory ANTI-inflammatory mediators: inhibit TNF alpha, COAGULATION system: situation in immunoparalysis - uncontrolled infection + multi organ failure

Question 6

PC of sepsis

Answer 6

o CNS = altered consciousness, confusion, psychosis
o Increased RR, Pa02 <70, Sats <90%
o Jaundice, decreased albumin, decreased platelets and increased D-dimer
o Tachycardic, arterial hypotension
o Oliguria, anuria, increased creatinine
o High lactate
o Skin mottling + reduced cap perfusion

Question 7

bacteraemia + septicaemia - difference?

Answer 7

bacteraemia - presence of bacteria in the blood stream.

septicaemia: presence of bacteria in blood stream + clinical manifestations = signs + symptoms

Question 8

SIRS
Sepsis
severe sepsis
septic shock

Answer 8

• systemic inflammatory response syndrome
• Sepsis: SIRS + documented infection
• Severe sepsis: End organ damage, high lactate

Septic Shock: sepsis + hypotension/hypoperfusion

Question 9

CURB65 SCORE?

Answer 9

assessment of mortality (point for each)

• tachypnoeic >22RR
• hypotensive <100mmHg
• High blood nitrogen
• > 65yo
• Confused

Question 10

most common causes of sepsis

Answer 10

gram (+)

• E.coli
• Strep pyogenes
• Pseudonomas aeruginosa
• Klebsiella