2. Sepsis

Question 1

What is the definition of sepsis?

Answer 1

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

Question 2

What is the definition of septic shock?

Answer 2

Persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation

Question 3

What is the definition of bacteraemia?

Answer 3

Presence of bacteria in the blood

Question 4

What are the 6 signs of sepsis?

Answer 4

Looks mottled, bluish or pale
Lethargic or difficult to wake
Abnormally cold to touch
Breathing very fast
Rash that does not fade when you press it - glass test
Has a fit or convulsion
NB high EWS

Question 5

Which aspects of the infection model with regards to the patient are important when considering sepsis as a differential diagnosis?

Answer 5

Age
Physiological state
Pathological state
Social factors
Relative time

Question 6

What is a rigor?

Answer 6

Shaking with fever

Question 7

Give 3 examples of infections that can lead to sepsis

Answer 7

Pneumonia
UTI
Meningitis

Question 8

What are the 6 things to do in the sepsis 6 bundle?

Answer 8

'Give 3, take 3'
Oxygen
Blood cultures (before IVaBs)
IV antibiotics
Fluid challenge
Lactate
Measure urine output

Question 9

What urgent investigations may be needed in suspected sepsis?

Answer 9

FBC, urea, electrolytes
EDTA bottle for PCR
Blood sugar
LFT
CRP
Coagulation studies
Blood gases
Other microbiology (lumbar puncture for CSF after checking contraindications, urine etc)

Question 10

What is the bacterial pathogen causes meningococcal meningitis? What class of bacteria is this?
(NB Can very rarely be a viral cause)

Answer 10

Neisseria meningitidis

Gram-negative diplococcus

Question 11

How is meningitis spread?

Answer 11

Direct contact with respiratory secretions and aerosols

Question 12

What is present on the cell surface of the neisseria meningitidis bacteria, which triggers inflammation? Give one other virulence factor?

Answer 12

Lipopolysaccharide endotoxin

Polysaccharide capsule - prevents phagocytosis. (Serogroup based on polysaccharide capsular antigen)

Question 13

How do endotoxins lead to sepsis via the inflammatory cascade?

Answer 13

Endotoxins binds to macrophage
Cytokines released locally (tissue necrosis factors and interleukins), and into circulation
Activation of humoral cascades and the reticuloendothelial system
Leads to circulatory insult, infection is not controlled, and sepsis

Question 14

How does an infection lead to the organ ischaemia (lack of O2), dysfunction and failure seen in sepsis?

Answer 14

Cytokines released:
Production of thrombin, promotes coagulation
Inhibits fibrinolysis
Coagulation cascade - microvascular thrombosis

Question 15

What leads to necrosis in sepsis?

Answer 15

Clotting involves large vessels
Body reassigns blood supply to vital organs
Extremities compromised - necrosis

Question 16

What is the usual antibiotic choice for treatment of meningitis?

Answer 16

Ceftriaxone

Question 17

What is the site of infection in bacterial meningitis?

Answer 17

Cerebral spinal fluid

Question 18

Name some life-threatening complication caused by sepsis due to meningitis?

Answer 18

Irreversible hypotension
Respiratory failure
Renal failure
Raised intracranial pressure
Ischaemic necrosis of extremities

Question 19

Which serogroup of meningitis predominates in the UK? Why is it more prevalent?

Answer 19

B

Capsule poorly immunogenicity and similar to neural tissue

Question 20

What can be given to close contacts of a patient with meningitis, to prevent meningitis in them and spread to other people (as meningitis can live harmlessly in some people)?

Answer 20

Antibiotic prophylaxis