CSIM 1.59: Sepsis

Question 1

What is systemic inflammatory response syndrome (SIRS)?

Answer 1

Inflammatory response to any insult (antigen, burn, trauma) affecting the whole body through release of the following inflammatory mediators:
• Thrombin
• NO
• Inflammatory cytokines

Question 2

What triggers SIRS/

Answer 2

• Prolonged hypoperfusion
  
  • Infection/toxins
  • Presence of large areas of damaged tissue

Question 3

What are the ‘SIRS criteria’?

Answer 3

Indications, the presence of 2 or more of which is defined as a SIRS definition:
  •  Temp > 38.3ºC
  •  Temp  90 bpm
  •  Respiratory rate > 20/min
  •  White cell count > 12x10^9/L
  •  Glucose over 7.7mmol/L

Question 4

What is ‘sepsis’?

Answer 4

SIRS + evidence of infection

Question 5

What is ‘severe sepsis’?

Answer 5

Sepsis + 1 sign of organ dysfunction:

• SBP

Question 6

What is septic shock? Describe its pathogenesis

Answer 6

Sepsis + hypotension
• Lysed bacterial cells release lipopolysaccharides
• These bind to LPS binding proteins to produce complexes which stimulate macrophages
• Macrophages release inflammatory cytokines (TNF, IL-1, IL-6, IL-12 and IFN-gamme) SYSTEMICALLY

Question 7

What consumes platelets in septic shock?

Answer 7

Disseminated intravascular coagulation

Question 8

What haemolysis is seen with the following?

1) Pyogenes
2) Enterococcus
3) Pneumoniae
4) Viridans

Answer 8

1) β
2) 𝛾
3) α
4) α

Question 9

Describe gamma-haemolysis

Answer 9

No haemolysis occurs

Question 10

What are the streptococcal toxins?

Answer 10

Steptolysin O
• Contributes to beta-haemolytic property

Streptolysin S
• Cardiotoxic

Streptococcal pyrogenic toxin
• Superantigen
• Responsible for scarlet fever rash and TSS symtoms

Streptokinase
• Activates plasminogen in to plasmin

Hylauranidase
• Breaks down hyaluronic acid in CT

Streptococcal chemokine protease
• Prevents migration of neutrophils

Question 11

Describe the management of sepsis

Answer 11

1) ABC
2) Screen for severe sepsis (1 sign of organ dysfunction)
3) Take microbiological samples
4) Give antibiotics
5) If sepsis severe - complete sepsis six within one hour. If not severe, reassess if the patient deteriorates

Question 12

What is sepsis six?

Answer 12

• Oxygen given
  
  • Blood cultures
  • IV antibiotics
  • Fluid resuscitation
  • Check lactate
  • Commence fluid balance (catheterisation if not producing urine)

Question 13

What are the types of necrotising fasciitis?

What is the mortality of this?

What role does it play in sepsis?

Answer 13

Type 1
• Anaerobic species
• Associated with immunosuppression and diabetes

Type 2
• Group A Streptococcus or Staph aureus
• Associated with TSS

30%

It can be the ‘source’ of the sepsis which causes shock