Defining a Syndrome

Question 1

What is colonisation?

Answer 1

Presence of microbe in body without inflammatory response?

Question 2

What is infection?

Answer 2

Inflammation in body due to microbe

Question 3

What is sepsis?

Answer 3

Dysregulated host response to infection causing organ damage

Question 4

What is septic shock?

Answer 4

Subset of sepsis with circulatory and cellular/metabolic dysfunction associated with higher risk of mortality

Question 5

How is septic shock defined?

Answer 5

Sepsis plus persistent hypotension despite adequate fluids requiring vasopressors to maintain MAP >= 65mmHg and lactate >= 2mmol/l

Question 6

What does SIRS stand for?

Answer 6

Systemic inflammatory response syndrome

Question 7

What is the underlying pathophysiology of SIRS?

Answer 7

Infection causes bacteria to enter blood = vessels become leaky causing organ dysfunction and subsequent death

Question 8

How is SIRS defined?

Answer 8

Non-specific clinical response plus >= 2 of following:
Temperature >38 or <36 Resp rate >20
Heart rate >90 WCC >12000 or <4000

Question 9

What are some causes of SIRS?

Answer 9

Sepsis, trauma, burns, pancreatitis

Question 10

How is sepsis defined using SIRS criteria?

Answer 10

Sepsis = SIRS with presumed or confirmed infectious process

Question 11

What was the issue with using SIRS criteria to diagnose sepsis?

Answer 11

SIRS proved to be too sensitive and not specific enough

Question 12

Where is the SOFA score used?

Answer 12

In intensive care environments

Question 13

What are the areas assessed by the SOFA score?

Answer 13

PaO2, platelets (coagulation), bilirubin (liver function), MAP, GCS, urine output and creatine (renal function)

Question 14

What is the qSOFA used for?

Answer 14

Screening for outcomes of infection

Question 15

What areas are looked at by the qSOFA?

Answer 15

Respiratory rate >22
Systolic blood pressure < 100mmHg
Altered GCS

Question 16

How is the qSOFA used to assess mortality?

Answer 16

<1% mortality if score is 0
2-3% mortality if score of 1
>=10% mortality if score >=2

Question 17

What are the areas assessed using the NEWS score?

Answer 17

Respiratory rate, O2 saturation, systolic blood pressure, pulse, AVPU, temperature

Question 18

What is the NEWS score used for?

Answer 18

Score calculated in each area and used to indicate how sick a patient is and how often they need to be monitored

Question 19

What questions should you ask when considering sepsis in a patient?

Answer 19

Does the patient look ill?
Have they triggered an early warning score?
Are there signs of infection?

Question 20

What NEWS score would be indicative of sepsis?

Answer 20

NEWS score >=5 plus signs of sepsis