Blood- Sepsis

Question 1

What is sepsis?

Answer 1

An immune response to infection that causes organ dysfunction

Question 2

What is septic shock?

Answer 2

A subset of sepsis, where the immune response is dysfunctional and alters metabolic activity.

There is persistant hypotension.

Question 3

What is SOFA?

and what criteria must a patient meet with qSOFA?

Answer 3

This is a test of the risk of a patient to developing sepsis:

1. Increased respiratory rate >22 /min
2. Decreased mentation (mental activty <15 on coma scale)
3. Low systolic blood pressure <100.

Question 4

What is organ dysfunction?

Answer 4

An acute change in the SOFA score of >=2

Question 5

What infections cause sepsis ?

Answer 5

Any infection can cause sepsis in an at risk individual

Question 6

Name the microbial factors that cause infections to proceed to sepsis?

Answer 6

Virulence factors:

• LTA (lipoteicloic acid)
• LPS
• Bacterial structures (pilli and fimbrae capsule )
• peptidoglycan.

Question 7

What are the host factors that cause infections to progress to sepsis?

Answer 7

• adaptive immunity
• Innate immunity
• Immuno-compromised patients
• Pre-existing chronic diseases
• Age
• Genetic

Question 8

Why are immunocompromised patient’s more at risk of sepsis?

Answer 8

Because microbes are more pathogenic (cause disease)

Question 9

Summarise the natural inflamatory response.

Answer 9

1. PAMPS and DAMPS activate innate immunity.
2. cytokines and chemokines are released to trigger inflammation
3. Cytokines activate vasodilation/ endothelial cells and vascular permeability.
4. Activation of complement
5. Pathogen eliminated.

Question 10

What is pathophysiology?

Answer 10

Dysfunction

Question 11

What dysfunction occurs in sepsis

Answer 11

Inflamatory dysfunction & immune supression

Question 12

Discuss the dysfunction with Inflammation that occurs in sepsis?

Answer 12

• inflammation causes tissue damage
• Damps and Pamps activating innate immunity
• HypoInflammation is sustained
• Complement and coagulation is activated

Question 13

Why is the activation of the coagulation system and complement bad in sepsis?

Answer 13

The overactivation can cause damage?

Question 14

Discuss the dysfunction with immune supression in sepsis

Answer 14

• apoptosis of B cells T cells and dysfunctional dendritic cells
• Delayed apoptosis of dysfunctional Neutrophils

Question 15

How do you treat sepsis?

Answer 15

IV antibiotics

IV fluids e.g. colloids

Vasopressors- e.g. noradrenaline which contracts the blood vessels to treat the hypotension

Question 16

How is sepsis relevant to dental practice?

Answer 16

Abscesses are a pottential sepsis trigger.

Question 17

How does an absess develop?

Answer 17

As a result of the acute inflamatory response to a bacterial infection.

Question 18

What does an absess contain?

Answer 18

• dead tissue
• immune cells
• live bacteria

Question 19

How do we treat an absess?

Answer 19

Drainage and excision (partial removal)

Question 20

What are the signs that a dental infection is spreading?

Answer 20

• temperature > or < 37
• reduced heart rate
• high respiratory rate > 22
• Trismus
• facial Swelling
• Dehydration.

Question 21

How do we identify patients at risk of sepsis?

Answer 21

Using qSOFA

Using SIRS

Question 22

What are the symptoms Systemic Inflammatory Response Syndrome and what it is used for?

Answer 22

Symptoms:

Tachycardia (heart rate >90 beats per minute)

Elevated respiratory rate (>20 breaths per minute)

Temperature >37* (fever) OR <36* (hypothermia)

SIRS criteria is used for diaognosing a systemic reponse to infection.