Acute Sepsis

Question 1

What does the ED have for urgent management of acute sepsis?

Answer 1

‘Sepsis bundle’

Question 2

What are some common signs of sepsis?

Answer 2

Generally unwell, temperature & chills (rigors)
Headache, nausea, general muscle aches, photophobia
Acute onset

Question 3

What are some common signs of meningitis?

Answer 3

Widespread purpuric, non-blanching rash
Nick stiffness
Raised temperature
Raised pulse

Question 4

What is the definition of sepsis?

Answer 4

Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection

(Host response has overreacted)

Question 5

What is septic shock?

Answer 5

Persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation

Question 6

What is bacteraemia?

Answer 6

The presence of bacteria in the blood (with or without clinical features)

Question 7

What are some things measured when calculating the EWS?

Answer 7

Basic observations - eg respiratory rate, heart rate, temperature, blood pressure

Question 8

What are some red flags?

Answer 8

High respiratory rate, low blood pressure, unresponsive

Question 9

What is the sepsis six?

Answer 9

Oxygen
Blood cultures
IV antibiotics
Fluid challenge
Lactate/FBC
Measure urine output

Question 10

What are some urgent investigations required when someone is believed to have sepsis?

Answer 10

Full blood count, urea and electrolytes
EDTA bottle for PCR
Blood sugar
Liver function tests
C-reactive protein
Coagulation studies
Blood gases
Other microbiology samples

Question 11

What is a common pathogen that causes meningitis?

Answer 11

Neisseria meningitidis

Question 12

What does the pilus enhance?

Answer 12

Attachment

Question 13

What is the function of the polysaccharide capsule?

Answer 13

Promotes adherence, prevents phagocytosis (protection)

Question 14

What does the lipopolysaccharide endotoxin released by Neisseria meningitidis trigger?

Answer 14

Inflammation

Question 15

What are some examples of cytokines?

Answer 15

Tissue Necrosis Factors and Interleukins

Question 16

What do cytokines initiate the production of?

Answer 16

Thrombin - thus promote coagulation

Question 17

What do cytokines inhibit?

Answer 17

Fibrinolysis - stops fibrin dissolving

Question 18

What is a major cause of shock and multiorgan failure?

Answer 18

Microvascular injury - results from coagulation cascade leading to microvascular thrombosis and hence organ ischaemia

Question 19

What is included int the supportive care of sepsis?

Answer 19

Early referral to ITU
Sepsis Six
Regular monitoring and reassessment

Question 20

What is the empiric choice of antibiotic for meningitis caused by Neisseria meningitidis?

Answer 20

Cetriaxone (can penetrate into the CSF)

Question 21

What are some life-threatening complications of sepsis?

Answer 21

Irreversible hypotension, respiratory failure, acute kidney injury, raised intracranial pressure, ischaemic necrosis of digits/hands/feet

Question 22

How is the diagnosis of sepsis confirmed?

Answer 22

Blood culture, PCR of blood, lumbar puncture (if safe)

Question 23

Is Neisseria meningtidis Gram-positive or Gram-negative?

Answer 23

Gram-negative

Question 24

What are the numerous serogroups of the meningococcus based on?

Answer 24

The polysaccharide capsular antigen

Question 25

What does the outer membrane of the meningococcus act as?

Answer 25

An endotoxin

Question 26

How is meningococcal disease spread?

Answer 26

Aerosols and nasopharyngeal secretions

Question 27

After meningococcus is acquired in the body, what are the three outcomes?

Answer 27

Clearance, carriage or invasion

Question 28

What is the fatality rate of meningococcal disease?

Answer 28

Around 10%