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Flashcards in Sepsis and Severe infections Deck (29):
1

What is SIRS?

Systemic inflammatory response syndrome Describes disseminated inflammation in response to a variety of clinical insults.

2

How is SIRS recognised?

Clinically recognised by the presence of two or more of the following:

Temperature >38.5 
Heart rate >90bpm 
Resp rate > 20 breaths/min
WCC >12

3

Define sepsis

SIRS resulting from a documented infection

4

Define severe sepsis

Sepsis associated with organ dysfunction, hypoperfusion or hypotension.

5

What is septic shock?

Severe sepsis with hypotension (systolic BP 40 mmHg from baseline) that is unresponsive to adequate fluid resuscitation.

6

How would you treat a patient you suspected to have severe sepsis?

Sepsis 6

1. Give high flow oxygen
2.Take blood cultures
3. Give empirical IV antibiotics

4. Measure FBC and serum lactate
5. Give IV fluid resuscitation
6. Measure urine output

7

State how you would assess organ dysfunction for 3 organs

Respiratory failure: Oxygen requirements
Circulatory failure: Low BP, high lactate, mottling
Renal failure: Urine output / Creatinine
CNS: Glasgow coma score
Coagulation: Low platelets, DIC
Liver: Lactate, low glucose

8

Name two causes of bacterial meningitis

  1. N. meningitidis
  2. S. pneumoniae 

    Also: Group B streptococci
    Haemophillus influenzae
    Listeria monocytogenes
    Mycobacterium tuberculosis.

9

Name two causes of viral meningitis

Enterovirus, VZV, HIV, mumps, measles

10

What are the three cardinal symptoms of meningitis?

Fever/headache, neck stiffness, photophobia

11

Name two causes of encephalitis

HSV, Rabies Also: VZV, HIV, arboviruses

12

How can you distinguish between a patient with meningitis and encephalitis

Both meningitis and encephalitis present as fever, headache and neck stiffness. In encephalitis because the brain tissue is infection patients also experience reduced consciousness, confusion and seizures

13

Why is a CT scan sometimes done before a lumbar puncture

Suspected mass or fluid raising intracranial pressure, could cause cerebellar herniation. Unconscious patients

14

What investigations are done in patients with CNS infections?

WCC

Blood cultures

Blood tests for antigen/PCR

Urine analysis for antigens

Throat swabs

Serology

CSF analysis from lumbar puncture

15

How is CSF analysed to determine cause of meningitis?

Cloudy appearance = bacterial meningitis

WCC: mostly neutrophils = bacterial, mostly lymphocytes = viral or TB

High protein = bacterial or TB meningitis

Low blood glucose = bacterial or TB meningitis

16

What are the treatments for meningitis?

Bacterial: ceftriaxone and dexamethasone (vancomycin + rifampicin in penicillin allergy)

Viral: aciclovir

TB: rifampicin, isoniazid, pyrazinamide, ehambutol and dexamethosone

17

Why is the incidence of MenB type bacterial meningitis higher than other serotypes?

No vaccine exists for MenB

18

Glasgow Coma Scale

Best motor response : Obeys commands   6
    Localising response to pain  5
    Withdraws from pain   4
    Flexor (decorticate) response 3
    Extensor (decerebrate) response 2
    No response    1

Best verbal response : Normal speech    5
    Confused speech    4
    Inappropriate speech (words only) 3
    Incomprehensible  (sounds only) 2
    No response    1

Best eye response : Eyes open spontaneously  4
    Eyes open to voice   3
    Eyes open to pain    2
    No response    1

19

Impetigo

Superficial skin disease common in children. Presents as weeping, exudative areas with honey-crust on the surface. Spread by direct contact. Caused by stapylococci (S. aureus) or BH-streptococci. Treated topically with fusidic acid or 1 week course of antibiotics

20

Erysipelas

Superficial infection of the dermis and upper subcutaneous layer of the face. Clearly defined. Caused by steptococci

21

Cellulitis

Hot, tender area of confluent erythema of the skin due to infection of deep subcutaneous tissue that spreads underneath the skin.

Often affects the lower leg. Pain at the site of inflammation in response to pressure

Caused by streptococcus (sometimes staph).

Athletes foot, fungal infections, diabetes at highest risk.

Treated with flucloxacilin (+ benzylpenicillin) N.B. can be mistaken for chronic venous insufficiency which is caused by poor circulation due to obesity

22

Necrotising fascilitis

Rapid spreading infection associated with widespread tissue destruction through all layers of the tissue. Commonly caused by GroupA Streptococci.

Characterised by severe pain beyond the site of initial infection followed by tissue necrosis. Infection spreads along the tissue causing spreading erythema, pain and sometimes creptius (from gas produced by bacterial respiration).

Clinical features: sepsis, discolouration (purple/black), pain and tenderness Investigations: indicators of sepsis, raised creatine kinase (if muscle involved), gas in soft tissues (late!)

Treatment: treat sepsis. Antibiotics (IV meropenem and IV clindamycin), surgical debridement

23

Undifferentiated febrile illness

Multiple infectious causes. Must take travel history, and full systems review. Incubations periods of infections can be an indicator.

Initial treatment is resuscitation and broad spectrum antibiotics. Blood investigations: FBC, ESR, U+E, LFT, CRP Microscopy: Blood, Urine, (sputum, faeces, CSF) Imaging: CXR, Echo, USS abdomen and pelvis

24

What are the signs and symptoms of benign malaria?

hot and cold sweats arthralgia + myalgia hepatosplenomegaly headache diarrhoea and vomiting anaemia

25

What are the signs and symptoms of falciparum malaria?

hypoglycaemia

haemorrhage

renal failure

coagulopathy

septic and hypovolemic shock

respiratoy failure

26

What investigations can be carried out for malaria?

Antigen test (ELISA kit) blood film

27

What is the treatment for malaria?

Benign malaria: chloroquine for 2days, followed by primaquine to eradicate

Falciparum malaria: quinine for 7 days followed by doxycycline for 7 days.

28

Treatment for necrotising fascilitis

Sepsis 6 IV

meropenem and clindamycin

Surgical debridement

29

How would you treat cellulitis?

Flucoxacillin + benzylpenicillin to target S> aureus and beta-haemolytic strep

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