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9. Infection (Medical Knowledge) > 2.4. Clinical Manifestations of Sepsis > Flashcards

2.4. Clinical Manifestations of Sepsis Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the Clinical Features of Sepsis dependent on?

A
  1. Host
  2. Organism (type)
  3. Environment
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2
Q

What Respiratory Dysfunction can occur in Sepsis?

A
  1. Tachypnoea (not just associated with chest infection)
  2. PaO2 less than 70mmHg (normal is > 80mHg)
  3. O2 Saturation less than 90%
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3
Q

What Cardiovascular Dysfunction can occur in Sepsis?

A
  1. Tachycardia
  2. Hypotension
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4
Q

What Liver Dysfunction can occur in Sepsis?

A
  1. Increase in Liver Enzyme production (deranged LFT’s)
  2. Decrease in Albumin
  3. Increase in Prothrombin Time (PT)
    Note - Jaundice can occur due to this
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5
Q

What Psychological / Neurological Dysfunction can occur in Sepsis?

A
  1. Altered consciousness (common in the elderly and very young, but can be present in normal individuals)
  2. Confusion
  3. Psychosis
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6
Q

What Renal Dysfunction can occur in Sepsis?

A
  1. Oliguria
  2. Anuria
  3. Increase in Creatinine
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7
Q

What Coagulation Dysfunction can occur in Sepsis?

A
  1. Decrease in Platelets
  2. Increase in Prothrombin Time (PT and Activated Partial Thromboplastin Time (APTT)
  3. Decreased Protein C
  4. Increased D-Dimer
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8
Q

What are the generic features of Sepsis?

A
  1. Fever (>38 degrees) / Hypothermia (<36 degrees)
  2. Tachycardia (>90bpm)
  3. Tachypnoea (>20 breaths/min)
  4. Altered Mental Status (especially in the elderly)
  5. Hyperglycaemia in the absence of Diabetes
    Note - Hypothermia is common in the elderly and the very young
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9
Q

Why might Hyperglycaemia, in the absence of Diabetes, occur in Sepsis?

A

Due to the Catabolic State of the body

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10
Q

What are the Inflammatory Variables in Sepsis?

A
  1. Leucocytosis (WCC > 12,000/ml)
  2. Leucopenia (WCC < 4,000/ml)
  3. Normal WCC with greater than 10% immature forms
  4. High CRP (not specific)
  5. High Procalcitonin (only elevated in bacterial infection)
    Note - Leucopenia is a bad sign body is unable to produce White Cells (too many anti-inflammatory (Th2) mediators)
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11
Q

What are the Haemodynamic Variables in Sepsis?

A
  1. Arterial Hypotension (Systolic < 90mmHg, or MAP < 70mmHg)
  2. SvO2 > 70%
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12
Q

What are the Organ Dysfunction Variables in Sepsis?

A
  1. Arterial Hypoxaemia
  2. Oliguria
  3. Creatinine increase (compared to baseline)
  4. Coagulation abnormalities (PT>1.5 or APTT>60s)
  5. Ileus (Abdominal distention)
  6. Thrombocytopenia (<150,000/ml)
  7. Hyperbilirubinaemia
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13
Q

In Sepsis, when does Arterial Hypoxaemia occur?

A

When the PaO2 / FiO2 is less than 50mmHg (Normal is > 80mmHg)

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14
Q

What is the definition of Oliguria?

A

Not able to produce much urine (<0.5ml/kg/hr)
Note - on a normal person this is about 35-40mls/hr

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15
Q

What is the Tissue Perfusion Variables in Sepsis?

A
  1. High Lactate
  2. Skin mottling and reduced Capillary Perfusion
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16
Q

What is the most important blood test when it comes to Sepsis?

A

Serum Lactate

17
Q

What does Serum Lactate tell us?

A

Whether the patient has tissue hypoperfusion or not
If Serum Lactate is high, there is reduced perfusion

18
Q

What are the Effects of the Host on Sepsis presentation?

A
  1. Age
  2. Co-morbidities
  3. Immunosuppression
  4. Previous Surgery (Splenectomy)
19
Q

What are some common Co-morbidities which would effect Sepsis?

A
  1. Chronic Obstructive Pulmonary Disease
  2. Diabetes Mellitus
  3. Congestive Cardiac Failure
  4. Disseminated Malignancy
20
Q

What are the different types of immunosuppression?

A
  1. Acquired - HIV / AIDS
  2. Drug-induced - Steroids, Chemotheraputic agents, biologics
  3. Congenital - Alpha-Gamma-Globulinaemia, Phagocytic defects, defects in terminal complement component
21
Q

What are the Effect of the Organism on the presentation of Sepsis?

A
  1. Gram Positive usually causes infection from above the diaphragm
  2. Gram negative usually causes infection from below the diaphragm
    Note - the treatment differs fro Gram Positive and Gram Negative, due to the different pathophysiologies
  3. Virulence factors (e.g. MRSA, Toxin secretion etc.)
  4. Bioburden
22
Q

What are the Effects of the Environment on the presentation of Sepsis?

A
  1. Occupation
  2. Travel
  3. Hospitalization

9. Infection (Medical Knowledge) (29 decks)

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