Basics

Question 1

SIRS criteria

Answer 1

Temp: >38 C (100.4 F)
• RR: >20 bpm (PaC02 <32 mm Hg)
• HR: >90 bpm
• WBC: >12,000/mm³ or <4000/mm³

Question 2

Sepsis vs severe sepsis vs septic shock

Answer 2

Sepsis: infection plus SIRS
Severe sepsis: sepsis + organ dysfunction
Septic Shock: severe sepsis + unresponsive to fluid challenge 6

Question 3

Describe the role of innate and active immunity in sepsis

Answer 3

Innate: provides immediate immunity with toll like receptors (TLR) killing microbes
Active: Amplifies innate immune system by stimulates cell mediated & humoral responses
• Types 1 Helper T Cell & Type 2 Helper T
• B lymphocyte cells :Release immunoglobulins

Question 4

Describe pro inflammatory cytokines and their role in sepsis

Answer 4

• Synergistic effects
• Stimulating inflammatory cascade
• Cytokines activated
• Monocytes, macrophages,
neutrophils
• Development of Fever, hypotension, capillary leakage &
myocardial depression
• Antiinflammatory cytokines
• Not fully understood
• “Proimmune” strategy
• Immunostimulators is beneficial

Question 5

Describe the coagulation effects of sepsis

Answer 5

Increase procoagulant factors and decreases anticoagulant factors
Extrinsic: Factor VII- thrombin
Intrinsic: Factor XI- procoagulant- thrombin
Inhibits protein C & S and antithrombin
Excessive thrombin and lack of thrombolysis produces DIC

Question 6

What are causes of micro circulatory dysfunction causes in sepsis

Answer 6

Endothelial cell dysfunction
• Increased leukocyte adhesion
• Microthrombi formation
• Dysfunction with flow
• Altered local perfusion pressure
• Functional shunting