Sepsis and Septic Shock Flashcards
(40 cards)
What are the 4 stages of systemic infection from SIRS to septic shock
SIRS (Systemic Inflammatory Response Syndrome)
Sepsis
Severe sepsis
Septic shock
What are the criteria for SIRS?
Temp >38 or 90
RR >20
PaCO2 12,000 or 10% bands
What is Sepsis?
SIRS + Infection
Defined as life threatening organ dysfunction caused by dysregulated host response to infection
What is Severe sepsis?
Sepsis + End organ damage
What is septic shock?
Severe sepsis + Hypotension
Give some examples of conditions that would classify as SIRS but have no infective component so could not lead to sepsis
Pancreatitis
Burns
Trauma
Other
How is organ dysfunction in sepsis identified?
Acute change in total SOFA score >2 points consequent to the infection
A SOFA score >2 reflects an overall mortality risk of what?
Approx 10% in a general hospital population with suspected infection
How can septic shock be identified?
A clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP >65mmHg and having a serum lactate of >2mmol/l despite adequate volume resuscitation
What is the hospital mortality of patients with septic shock?
40%
What is measured in a Sequential Organ Failure Assessment Score?
Respiration
-PaO2/FiO2
Coagulation
-platelets
Liver
-Bilirubin
Cardiovascular
-MAP
CNS
-GCS
Renal
- Creatinine
- Urine output
What are the criteria for the quick SOFA (qSOFA)?
RR >22/min
Altered mentation
Systolic BP
What window would be the best for starting antimicrobial chemotherapy in someone with septic shock?
30 mins
Basically as soon as possible (every minute matters)
For each hour’s delay in administering antibiotics in septic shock, mortality increases by how much?
7.6%
What 3 broad things make up the bodies defences against sepsis?
Give examples of each
Physical barrier
-Skin, mucosa, epithelial lining
Innate immune system
-IgA in gastrointestinal tract, dendritic cells/ macrophages
Adaptive immune system
-Lymphocytes, Immunoglobulins
What is the origin of sepsis?
The basic event which causes sepsis
Breach of integrity of host barrier, whether physical or immunological
Organism enters the bloodstream creating a septic state
Patients with sepsis have features consistent with immunosuppression.
Give 3 examples
Loss of delayed hypersensitivity
Inability to clear infection
Predisposition to nosocomial (HAI) infection
Give 3 ways the sepsis syndrome can probably change over time
Initially there is an increase in inflammatory mediators
Later, there is a shift toward an anti-inflammatory immunosuppressive phase
Depends on the health of the individual
What are the 3 phases in the pathogenesis of sepsis?
Release of bacterial toxins
Release of mediators in response to infection
Effects of specific excessive mediators
What commonly released gram negative toxins are there?
Lipopolysaccharide (LPS)
What commonly relaesed gram positive toxins are there?
(2 types
-2 examples for each)
Microbial-associated molecular pattern (MAMP)
- Lipoteichoic acid
- Muramyl dipeptides
Superantigens
- Staphylococcal toxic shock syndrome toxin (TSST)
- Streptococcal exotoxins
What 2 broad types of toxins can bacteria release?
Endotoxin
Exotoxin
How does gram positive and gram negative endotoxin binding differ?
Gram negative
-LPS -> needs an LPS-binding protein to bind to macrophages
Gram positive
-LTA do not need such proteins
Why are superantigens named as such?
Small amounts of superantigens will cause a large amount of mediators to be secreted: cascade effect
“cytokine storm”
