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Year 2 - CLASP > Sepsis > Flashcards

Sepsis Flashcards

(40 cards)

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1
Q

Define the following terms:

  • Colonisation
  • Infection
  • Bacteraemia
  • Sepsis
  • Septic shock
A

Colonisation - the presence of a microbe in the human body without an inflammatory response

Infection - Inflammation due to a microbe

Bacteraemia - the presence of viable bacteria in the blood

Sepsis - the dysregulated host response to infection, resulting in life-threatening organ dysfunction

Septic shock - subset of sepsis with circulatory and/or metabolic dysfunction, and carries a much higher risk of mortality. NB - by definition, septic shock cannot occur prior to resus, as resus must have been attempted and the patient fail to respond

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2
Q

What diagnostic tools exist to establish whether or not a patient is septic?

A

SIRS (fallen out of favour)

NEWS-2

qSOFA

NICE guidelines

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3
Q

Sepsis 6 - what are they?

A

Give 3, Take 3

Give

  • Oxygen
  • Fluid resuscitation
  • Stat IV antibiotics

Take

  • Bloods for culture
  • Lactate, FBC and biochemistry urgently
  • Urine, and monitor urine output
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4
Q

Why is SIRS not thought to be useful?

A

Not everyone that SIRS clarifies as septic will be infected/be septic, SIRS is too sensitive and not specific enough

SIRS may also detract from the search for an infection in a patient

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5
Q

What are the parameters used in qSOFA? What is it used to predict?

A

RR > 22 bpm

sBP < 100 mmHg

Altered GCS

Used to predict morality - if one of the above then mortality = 2-3%, if 2 or more of the above then mortalitly is +10%

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6
Q

A NEWS score of what means that a diagnosis of sepsis should be considered?

A

A NEWS score greater than 5

Higher the number = higher the rate of mortality

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7
Q

What is the new simplistic way of thinking that a diagnosis of sepsis could be possible, related to NEWS?

A

Does the patient look ill?

Are they triggering an early warning score?

Are there signs of infection?

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8
Q

At what points are the NEWS trigger thresholds set?

A

1-4

3 in a single parameter

5 or more is urgent response threshold

7 or more is emergency response threshold

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9
Q

What types of fluid can be given in fluid resus for sepsis?

A

Crystalloids

Colloids

Albumin

Blood

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10
Q

How is fluid resus done in treating sepsis?

A

Initially fluid challenge with bolus of 500ml, followed by 30ml/kg and monitor response.

Continue to reassess and monitor urine on an hourly basis

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11
Q

What is the standard amount of fluid that is given to patients?

A

30 ml per kg of bodyweight

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12
Q

What is the minimum amount of urine you would want to see from a patient?

if less than this, what could this indicate?

A

At least 0.5ml per kg of bodyweight per hour

Less than this could indicate hypoperfusion of kidneys

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13
Q

How might a raised lactic acid level present in patients?

A

Raised lactic acid can result in lactic acidosis, the body will try to compensate by blowing off excess CO2 to restore normal pH = rapid shallow breathing

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14
Q

What further treatments can be given to restore normal BP?

What MAP is aimed for to ensure organ perfusion?

A

Inotropes/Vasoconstrictors - noradrenaline (alpha agonist), adrenaline (mixed alpha and beta agonist)

a minimum MAP of 65 mmHg is aimed for

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15
Q

What % of the population is genuinely allergic to penicillin?

A

Less than 0.05%

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16
Q

Give some examples of beta lactams

A

Penicillin

Flucloxacillin

Amoxicillin (a.k.a. Ampacillin - almost identical)

Cephalosporins

Piperacillins/tazobactam

Carbapenems

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17
Q

What is the only one of the cephalosporins that is active against Pseudomonas?

18
Q

How does Clavulanic acid help against beta lactamases?

Study These Flashcards
A

Helps to inhibit the beta lactamase of bacteria, allowing the penicillin to work

19
Q

What is the only class of drug that is effective against ESBLs?

20
Q

Name some gram negative bacilli

Study These Flashcards
A

Coliforms

Psudomonas

H pylori

H. influenzae

Klebsiella

21
Q

In sepsis, a bacteriostatic/bacteriocidal antibiotic is given.

how are these defined?

Study These Flashcards
A

Bacteriocidal

if there is more than a 1000-fold decrease in bacteria then it is classed as bacteriocidal

22
Q

What needs to be kept in mind when prescribing dose for beta lactams?

Study These Flashcards
A

Regular doses are required to ensure the dose remains above the MIC

23
Q

Which gram negative bacilli is NOT killed off by ceftriaxone?

24
Q

What important question should you remember to ask a patient presenting with a likely sepsis when considering what treatment to prescribe (other than allergies!)?

Study These Flashcards
A

Have you been on holiday recently? Worry about ESBLs!

25
Mark is admitted to hospital with fevers, a swollen thigh, a discharging right groin wound and a cough over the preceding two days. He injects heroin into his thigh. He always uses the needle exchange. He has a fever of 39 degrees, BP 90/60, pulse 130 bpm. He is confused but has no focal neurology. RR is 28 and he has a newly raised creatinine. **What test would you like to perform next, out of the following...?** **- CT abdomen and pelvis** **- CT Brain** **- MRI Brain** **- Echocardiography**
Echocardiography
26
Which of the following antibiotics have an antitoxin effect? - Flucloxacillin - Piperacillin-tazobactam - Linezolid - Vancomycin - Clindamycin
Linezolid and Clindamycin both have antitoxin effects
27
Which of the following antibiotics is likely to be reliably active against ESBL producing coliforms in the blood? - IV piperacillin-tazobactam - IV meropenem - IV amoxicillin - IV flucloxacillin - IV co-amoxyclav
**IV meropenem** (only antibiotic effective against ESBLS are the carbapenems)
28
When seeing a patient presenting with a likely E. coli infection (i.e. recent contact with animals, recently attended a barbecue, recent onset of bloody diarrhoea), why should antibiotics NOT be given?
Because of the risk of Haemolytic Uraemic Syndrome
29
What drugs make up the 4Cs?
Co-amoxyclav Cephalosporins Clindamycin Ciprofloxacin (and all other quinolones) NB - all antibiotics are capable of leading to C diff infection, the 4Cs just carry the highest risk
30
If a patient presents with infective endocarditis, how long will they need to be on antibiotic therapy for?
6 weeks
31
Where are anaerobes typically found? What diseases might they lead to? What is the standard treatment for anaerobes
Found in the mouth, teeth, throat, sinuses and lower bowel, considered 'dirty' organisms May lead to abscesses, dental infections, peritonitis or appendicitis Typically treated with **metronidazole**
32
Where are gram positive organisms typically found? What conditions might they cause? What class of antibiotic is the treatment of choice when generally dealing with gram positive organisms?
Found on skin and mucus membranes May cause pneumonia, sinusitis, cellulitis, osteomyelitis, wound infection and line infections **Penicillins** are the treatment of choice for gram positives
33
Name an antibiotic that **ONLY** treats gram positives
Vancomycin
34
Where are atypical organisms usually found? What conditions can they cause? What group of patients do they pose the biggest problem in?
Atypicals are usually found in the chest or genito-urinary system They can cause pneumonia, urethritis and pelvic inflammatory disease Atypical organisms cause the most issues for immunocompromised/immunosuppressed individuals
35
Where are gram negative organisms typically found? What conditions can they cause? What is the treatment of choice for gram negatives?
Typically found in the GI tract Can cause UTIs, peritonitis, biliary infections, pancreatitis and pelvic inflammatory diseases. **Gentamicin** is the treatment of choice.
36
What infections would an HIV patient be susceptible to at the following CD4 cell counts... - CD4 \<350 - CD4 \<200 - CD4 \<100
\<350 - **Mycobacterium tuberculosis, Candidiasis** \<200 - **Pneumocystis jirovecii, Toxoplasma gondii** \<100 - **Cryptococcus neoformans, CMV**
37
Name some diseases caused by spirochetes
Syphilis Lyme disease
38
Name some Alpha-haemolytic Strep
Strep pneumoniae Strep viridans
39
Name some Beta-haemolytic Strep
Group A Strep (S. pyogenes) Group B Strep
40
Name a Non-Haemolytic Strep
Enterococcus

Year 2 - CLASP (1 decks)

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