3: Sepsis

Question 1

What does activation of the inflammatory cascade lead to? (2 things)

Answer 1

1. Activation of coagulation

2. Deposition of fibrin

Question 2

What criteria define Systemic Inflammatory Response Syndrome (SIRS)? (6 things)

Answer 2

1. Temp over 38.3C or under 36C
2. Pulse over 90bpm
3. RR over 20/min
4. New confusion / drowsiness
5. WBC over 12 or under 4x10^9/L
6. Blood glucose over 7.7 mmol/L (non-diabetic patients)

2+ of the above present = SIRS

Question 3

What is the Septic Six Bundle?

Answer 3

6 things that have to be done in the first hour of identifying Sepsis:

1. Give O2
2. Measure Lactate (Treatment performance marker)
3. Take blood cultures
4. Give antibiotics immediately (broad spectrum)
5. Give fluid challenge of 30ml/kg for BP less than 90
6. Measure strict fluid balance (consider catheterisation… to be able to measure input vs output accurately)

Question 4

What are the SOFA criteria?

Answer 4

1. Respiratory - PaO2/FiO2 ratio
2. Haematology - Platelet count
3. Liver - Serum bilirubin
4. Renal - Serum creatinine (or urine output)
5. Brain - Glasgow Coma Scale
6. CVS - Hypotension and Vasopressor requirement

Suspected infection AND change in 2+ of above from baseline

Question 5

How do micro-organisms trigger the inflammatory cascade? (4 things)

Answer 5

• Gram -ve (e.g E coli) bacteria main cause of sepsis
• Gram -ve have lipopolysaccharide (LPS)
• LPS activates MAC n NK cells
• MAC n NK activate +ve feedback loop —> amplifies immune response —> innate system responds quickly to infection