Chapter 2: Sepsis syndrome

Question 1

definition of severe sepsis

Answer 1

severe infection leading to organ dysfunction (bacteremia doesnt necessarily result in sepsis)

sepsis is defined as systemic inflammatory response syndrome due to bacteremia (SIRS)

Question 2

what is sepsis syndrome

Answer 2

continuum of manifestations of clinical symptoms

Question 3

characteristics for bacteria that causes bacteremia

Answer 3

G- with Lipopolysaccharide(an endotoxin) (e.coli or kbesiella)
G+ toxic shock syndrome toxin 1 by S. aureaus

Question 4

what are the characteristics of SIRS systemic inflammatory response syndrome

Answer 4

HR > 90 bpm
RR >20 b/m
fever >38 or hypothermia <36
increased peripheral WBC count >12,000 or leukopenia <4000
increased immature neutrophil

Question 5

definition of septic shock

Answer 5

sepsis accompanied by hypotension <90mmhg that initially responds to fluids

Question 6

what can cause SIRS

Answer 6

viruses (dengue fever)
fungi (candida)
pancreatitis

Question 7

pathogenesis of septic shock

Answer 7

infection=>SIRS=>Sepsis=>severe sepsis=>septic shock

Question 8

pathophysiology of DIC (disseminated intravascular coagulation)

Answer 8

bacterial products activates TF (tissue factor) that activates extrinsic coagulation cascade thrombin stimulates fibrinogen conversion to fibrin which causes consumption coagulopathy and microvascular thrombosis

Question 9

pathogenesis of septic shock

Answer 9

capillary leak=> intravascular volume loss=> warm shock due to peripheral vasodilation=> cold shock accompanied by decreased cardiac output often accompanied by respiratory distress syndrome with fluids building up in the lungs=> shift from TH1(cellular response) to TH2 (humoral response) causing immunocompromise

Question 10

should you wait for antibiotic administration until blood cultures results come back

Answer 10

when the patient has sepsis, don’t delay treatment because every one hour delay increases mortality rate, so indicate antibiotic therapy. bacteria like P. aeruginosa and candida has increased mortality rates so make sure to cover them

Question 11

the more you know about ARDS

Answer 11

sepsis is the leading cause of ARDS

Question 12

acute management of sepsis

Answer 12

every hour delay increases morality rate by 7.6%
activate the sepsis 6 bundle(blood cultures, check full blood count and lactate, IV fluid challenge, IV antibiotics, monitor urine output and give oxygen.) and complete within 1 hour

take into account the primary site of infection
local hospital antibiotic sensitivities
readjust based on the bloods culture results

Question 13

what’s the continued management of sepsis (after the first hour)

Answer 13

major concerns: hypotension and hpoperfusion, monitor BP, serum lactate, skin color and temperature of the extremities
maintain BP>65mmhg
serum lactate >4 m/M/L mortality of 40%
if continued hypotension and hypo perfusion after sepsis 6 bundle, monitor CVP (central venous pressure)
use crystalloid solution to avoid hyperchloremia
vasoconstrictor of choice is norepinephrine
dopamine increases the risk of arrhythmias

Question 14

what are the compliations of sepsis

Answer 14

ARDS
DIC
elevated PT and PTT and low fibrinogen and high D-dimers (marker for increased clotting activity)
thrombocytopenia (treat with frozen plasma)

Question 15

adjunctive therapies for sepsis syndrome

Answer 15

corticosteroids in low doses MAY be beneficial

the rest is questionable due to irreversibility and rapid progression of the syndrome