1: SEPSIS

Question 1

Define Sepsis

Answer 1

Life-threatening organ dysfunction due to dysregulated host response to infection

Question 2

Define septic shock

Answer 2

Sepsis in combination with:

• Lactate more than 2
• Vasopressors to maintain MAP at more-than 65mmHg

Question 3

Give 5 risk factors for sepsis

Answer 3

1. Immunocompromised
2. <1 of >75
3. Recent procedure in past 6 weeks
4. Indwelling lines
5. Women who were pregnant, had TOP or miscarriage in past 6 weeks

Question 4

What 7 factors are considered when determining risk of sepsis

Answer 4

• Mental status
• Urine output
• Signs infection
• RR
• HR
• T
• RF

Question 5

How is risk of sepsis stratified

Answer 5

Low Risk
Moderate Risk
High Risk

Question 6

Describe the following in moderate sepsis

a. Mental status
b. RR
c. SBP
d. HR
e. T
f. Urine Output
g. Infection
h. RF

Answer 6

a. Subjectively altered
b. 21-24
c. 91 - 100
d. 91 - 130, or new dysarrythmia
e. <36 OR riggers
f. No urine in 12-18h
g. Signs infection from wounds
h. Immunocompromised

Question 7

Describe following in high-risk sepsis

a. Mental status
b. RR
c. HR
d. BP
e. Urine output
f. signs of infection

Answer 7

a. Objectively deteriorated (GCS)
b. >24, or new requirement for 40% FIO2
c. >130
d. <90
e. No urine output for 18h
f. mottled, ashen skin

Question 8

How is high-risk sepsis managed

Answer 8

• Immediate senior review
• ABG, FBC, CRP, U+E, Coagulation Profile
• Antibiotics (1h)
• Obs every 30 minutes
• Bloods every 15 minutes

Question 9

How is moderate risk sepsis (2 factors) managed

Answer 9

• Senior review in 3h

- ABG, BC, FBC, CRP, U+E, Coagulation Profile

Question 10

How is moderate risk sepsis (1 factor) managed

Answer 10

• Bloods in one hour

Question 11

What is a mnemonic to remember management of sepsis

Answer 11

BUFALO

Question 12

How is sepsis managed

Answer 12

Blood cultures
Urine output 
Fluid (500ml Saline)
Antibiotics
Lactate
Oxygen

Question 13

What antibiotic is given in sepsis

Answer 13

Co-amoxiclav and gentamicin

Question 14

When is amikacin offered opposed to gentamicin

Answer 14

If individual has been abroad in hospital anywhere in past 6-months

Question 15

When is metronidazole added in sepsis

Answer 15

Intra-abdominal pathology

Question 16

What score is used to identify patients at risk of mortality in sepsis

Answer 16

qSOFA

Question 17

What is the qSOFA score

Answer 17

• RR >22
• Altered consciousness: GCS < 15
• Systolic BP <100

Question 18

What qSOFA score indicates individual is at-risk of mortality

Answer 18

> 2

Question 19

If individuals have a qSOFA score of more than 2 what is done

Answer 19

Full SOFA

Question 20

Define minimum inhibitory concentration

Answer 20

Minimum concentration of antibiotic required to inhibit growth of bacteria overnight

Question 21

Define minimum bactericidal concentration

Answer 21

Minimum concentration of antibiotic required to kill bacteria overnight

Question 22

What is an allergy

Answer 22

IgE mediated hypersensitivity to an allergen that presents with predictable symptoms on ingestion, inhalation or contact

Question 23

How does an allergy present clinically

Answer 23

• Rash
• Urticaria
• Hives
• Itching eyes

Anaphylaxis: bronchoconstriction. HTN, oedema

Question 24

What is a side effect

Answer 24

Unintended effect of drug occurring at doses normally used and relating to properties of the drug

Question 25

What are anaphylactoid reactions

Answer 25

Similar picture to anaphylaxis but not IgE mediated