Week 2 -Acute Sepsis Flashcards
What are the clinical features of systemic inflammatory response syndrome - SIRS
Two or more of the following:
Temp 38
Heart rate >90
Resp rate >20 or paco2 12x10’9/L
What is the basis for a diagnosis of sepsis?
SIRS and documented or presumed infection
What is the definition of severe sepsis?
SIRS + organ dysfunction or organ hypo fusion resulting in hypotension, decreased urine etc
What is the definition of septic shock?
Severe sepsis and persistently low BP despite IV fluids
Describe neissera meningitis in terms of gram staining and shape
NM is gram negative and diplococci
Who is likely to catch neisseria meningitis?
Everyone (except neonates)
What are the causes for newborns? Describe the gram staining and the shape
Group B streptococcus (g+)
E. coli (g- bacilli)
Listeria monocytogenes (g+ bacilli)
What bacteria are most likely to cause meningitis in children? Describe gram staining and shape
Haemophilia influenza type b - gram -ve coccobaccilary
Neisseria meningitis - gram -ve diplococci
Streptococcus pneumonia - gram +ve
What are the causes of meningitis in adults? Describe the gram staining and the shape
Neisseria meningitidis - gram neg diplococci
Streptococcus pneumonia - gram pos
Haemophilus pneumonia type b - gram neg coccobaccilary
Listeria monocytogenes - gram positive bacilli (anaerobic)
What are the causes of meningitis in the elderly? Describe the gram staining and the shape
Listeria monocytogenes- gram positive bacilli
Tb - mycobacterium
Strep pneumonia - gram positive
Why is microvascular injury the major cause of shock and multi organ failure?
Cytokines initiate production of thrombin and thus promote coagulation. They also inhibit fibrinolysis. Coag cascade leads to microvascular thrombosis and hence organ ischaemia.
Why do we look for C reactive protein in patients we suspect of sepsis?
The levels will rise in response to inflammation - it is of hepatic origin and levels will increase in response to interleukin 6 secretion by macrophages and T cells.
Apart from liver failure there are few known factors that will interfere with CRP production.
What are the sepsis 6 to be delivered in one hour?
Deliver high flow o2 IV antibiotics IV fluids Urine output Measure serum lactate levels Blood cultures and consider source control
Which antibiotic would be consider for neisseria meningitidis?
Ceftiaxone - cephalosporin
When would you not do a spinal tap to take a sample of CSF.
Raised ICP - coming
