B2 W2 - Severe Infection and Sepsis Flashcards
What is the definition of infection?
Infection is defined as the invasion and multiplication of pathogenic microbes in an area of the body where they are not normally present, which normally leads to disease.
What does SIRS stand for, and what is it?
SIRS stands for systemic inflammatory response syndrome. It is an inflammatory response to infection or a non-infectious insult that affects the whole body.
How was sepsis defined in 1991?
Sepsis was defined as the situation where the body’s response to infection causes injury to its own tissues and organs.
What are the criteria for severe sepsis according to the 1991 definition?
Severe sepsis was defined as sepsis (infection plus SIRS) along with organ dysfunction.
What characterises septic shock?
Septic shock is a severe form of sepsis characterised by low blood pressure despite fluid administration, along with perfusion abnormalities.
What are some examples of perfusion abnormalities in septic shock?
Perfusion abnormalities include reduced conscious level, decreased urine output, and lactic acidosis.
Why was the SIRS definition updated in 2001?
The SIRS definition was updated to include additional parameters found to be linked with sepsis through data analysis.
What two parameters were added to the SIRS definition in 2001?
Blood glucose (excluding patients with diabetes) and altered mental status were added to the SIRS definition.
What is a “red flag” feature in the context of sepsis?
“Red flag” features are clinical signs that indicate a high likelihood of severe sepsis, such as a purpuric rash, extremely high heart rate, or very low blood pressure.
How was the definition of sepsis redefined in 2016?
The 2016 definition shifted focus to organ dysfunction and poor prognosis, aligning more with what was previously termed “severe sepsis”.
What is the key qualitative definition of sepsis according to the 2016 guidelines?
Sepsis is defined as “a life-threatening organ dysfunction due to a dysregulated host response to infection”.
How is septic shock defined in the 2016 guidelines?
Septic shock is a subset of sepsis where profound circulatory, cellular, and metabolic abnormalities significantly increase mortality.
What is the SOFA score?
The SOFA score is a comprehensive scoring system used in intensive care to identify organ dysfunctionin sepsis.
What does qSOFA stand for, and what is its purpose?
qSOFA stands for quick SOFA. It is a bedside score using respiratory rate, altered cognition, and low blood pressure to identify patients with suspected infection who are likely to have poor outcomes.
What are the three criteria used in the qSOFA score?
The qSOFA score assesses respiratory rate, mental status (using the Glasgow Coma Scale), and systolic blood pressure.
What are some severe infections that can potentially lead to sepsis?
Severe infections that can lead to sepsis include meningitis, encephalitis, pneumonia, infective endocarditis, pyelonephritis, cellulitis, necrotizing fasciitis, and septic arthritis.
What is the Sepsis Six?
The Sepsis Six is a bundle of care measures that should be implemented quickly for patients with suspected sepsis.
List the six components of the Sepsis Six.
The Sepsis Six includes: (1) High-flow oxygen, (2) Blood cultures, (3) Empirical antibiotics, (4) Full blood count and lactate measurement, (5) Intravenous fluid resuscitation, (6) Accurate urine output measurement.
What should be done if a patient doesn’t respond to the Sepsis Six?
If a patient does not respond to the Sepsis Six, the critical care team should be contacted for further management.
What are some concerns regarding the heightened awareness of sepsis?
There are concerns that sepsis awareness has led to an overdiagnosis of sepsis and overuse of antibiotics in patients without confirmed infection.
What potential negative consequences can arise from the overuse of antibiotics?
Overuse of antibiotics can lead to diagnostic difficulties by suppressing microbial growth and contribute to the development of antibiotic resistance.
What is Early Goal-Directed Therapy (EGDT) and when is it used in sepsis management?
EGDT is a more intensive treatment approach used in sepsis when a patient does not respond to the initial Sepsis Six bundle. It involves close monitoring of central venous pressure and may necessitate the use of vasopressors and inotropes to stabilise blood pressure and support heart function.
Explain the role of steroids in treating sepsis.
While steroids are immunosuppressants, they can be beneficial in certain sepsis cases where the body’s overwhelming inflammatory response is causing more harm than good. Steroids help to dampen this excessive inflammation. They have proven to be particularly effective in improving the prognosis of COVID-19 patients experiencing severe sepsis-like complications.
Why are local sepsis protocols and antibiotic guidelines important?
Local guidelines are essential because they are tailored to the specific hospital environment, taking into account factors like local patterns of antimicrobial resistance. This ensures that patients receive the most appropriate empirical antibiotics even before a definitive microbiological diagnosis is confirmed.