2.1. Definition of Sepsis

Question 1

What are the 4 stages of the traditional model of “Sepsis”?

Answer 1

1. Systemic Inflammatory Response Syndrome (SIRS)
2. Sepsis
3. Severe Sepsis
4. Septic Shock

Question 2

What can cause Systemic Inflammatory Response Syndrome (SIRS)?

Answer 2

1. Infection
2. Pancreatitis
3. Burns
4. Trauma (Surgery)
5. Other things (Exercise)

Question 3

In Systemic Inflammatory Response Syndrome (SIRS), how does the patients

1. Temperature change?
2. Heart rate change?
3. Respiratory rate change?
4. PaCO2 change?
5. White Cell Count change?

Answer 3

1. Temperature increases above 38 degrees, or decreases below 26 degrees
2. Heart rate increases to above 90 bpm
3. Respiratory rate increases to above 20 breaths per minute
4. PaCO2 decreases to less than 32
5. White Cell Count increases above 12,000, or decreases below 4,000

Question 4

Is a low White Cell Count in Systemic Inflammatory Response Syndrome (SIRS) indicative of a good or poor prognosis?

Answer 4

Poor

Question 5

What is the definition of “Sepsis”?

Answer 5

Life-threatening organ dysfunction caused by a dysregulated host response to infection
Note - Sepsis is not due to the infection but the body’s response to the infection - it is not the right type of response which can lead to death

Question 6

What is “Sepsis”, in terms of the traditional model of Sepsis?

Answer 6

Systemic Inflammatory Response Syndrome (SIRS) with infection

Question 7

What is the scoring system used to assess organ dysfunction (caused by Sepsis)?

Answer 7

1. SOFA - Sequential (Sepsis Related) Organ Failure Assessment Score
2. qSOFA - quick Sequential (Sepsis Related) Organ Failure Assessment Score

Question 8

What are the components of the SOFA?

Answer 8

1. Respiratory - PaO2 / FiO2
2. Coagulation - Platelet count
3. Liver - Bilirubin count
4. Cardiovascular - Mean arterial pressure (+ presence of Dopamine, Adrenaline, or Noreadrenaline)
5. CNS - Glasgow Coma Scale score
6. Renal - Creatinine, Urine output
   Note - Scored from 0 to 4, higher scores are worse

Question 9

What are the components of the qSOFA?

Answer 9

1. Hypotension (Systolic Blood Pressure <100mmHg)
2. Altered mental status
3. Tachypnoea (Respiratory rate > 22/min)

Question 10

What SOFA score is indicative of organ dysfunction as a consequence of infection?

Answer 10

2+

Question 11

What qSOFA score is indicative of organ dysfunction as a consequence of infection?

Answer 11

2+

Question 12

What does a SOFA score greater than 2 reflect?

Answer 12

An overall risk of approximately 10% in a general hospital population with suspected infection

Question 13

What is the “Severe Sepsis”, in terms of the traditional model of Sepsis?

Answer 13

Sepsis + end organ damage

Note - severe sepsis no longer exists in the current models

Question 14

What is the definition of “Septic Shock”?

Answer 14

A Clinical Construct of Sepsis with:

1. Persisting Hypotension requiring vasopressors to maintain a Mean Arterial Pressure (MAP) >65mmHg
2. Serum lactate >2mmol/L despite adequate volume resuscitation

Question 15

What is “Septic Shock”, in terms of the traditional model of Sepsis?

Answer 15

Severe Sepsis (Sepsis (dysregulated response) + end organ damage) + Hypotension

Question 16

What is the hospital mortality for those in Septic Shock?

Answer 16

40%