[EMed] Sepsis

Question 1

what is sepsis?

Answer 1

life-threatening organ dysfunction due to dysregulated host response to infection

Question 2

what is septic shock?

Answer 2

persistent hypotension (SBP <90mmHg or MAP<65mmHg) or lactate <2

DESPITE fluid resuscitation (30mL/kg)

Question 3

what is the qSOFA score?

Answer 3

bedside assessment tool to predict poor outcomes

Question 4

what are the components of the qSOFA score?

Answer 4

HAT:
H - hypotensive (SBP <90mmHg)
A - altered mental status
T - tachypnoea (RR>22)

Question 5

when do you suspect sepsis?

Answer 5

> 1 risk factors:

• new altered mental state
• RR>25/min
• new need for >40% O2 to maintain sats >92%
• HR >130bpm
• SBP <90mmHg or 40mmHg less than normal
• UO <0.5mg/kg/hr

Question 6

what do you do when you suspect sepsis?

Answer 6

take 3 tests:

• bloods incl. lactate
• blood cultures
• urine output

give 3 treatments:

• broad-spectrum abx
• cystalloid fluids (20ml/kg)
• O2 if needed to maintain sats >92%

all should be completed <60 mins

Question 7

what is done after sepsis 6?

Answer 7

reassess regularly and consider ICU review if failure to respond to initial medical treatment

Question 8

what is neutropenic sepsis?

Answer 8

pt with neutrophils 0.5x10^9/L and either:

• temp >38˚C or
• signs and sx of infection

Question 9

what are the risk factors for neutropenic sepsis?

Answer 9

• immunosuppressant meds
  e. g. chemo, hydroxychloroquine, methotrexate, cyclosporin, infliximab
• indwelling devices e.g. central venous access

Question 10

what is the rx for neutropenic sepsis?

Answer 10

broad-specturm abx e.g. Piperacillin-Tazobactam (Tazocin)

Question 11

what is meningitis?

Answer 11

inflammation of the lining of the brain and spinal cord (meninges)

Question 12

how do pts with meningitis present?

Answer 12

• fever
• headache
• neck stiffness
• vomiting
• altered mental state
• non-blanching rash (meningococcal)

Question 13

what are the bacterial pathogens responsible for bacterial meningitis?

Answer 13

NHS:
N - neisseria meningitides (meningococcal)
H - haemophilus influenza
S - strep. pneumonia (pneumococcus)

Group B strep (neonate)
Listeria monocytogenes

Question 14

what is the ix for meningitis?

Answer 14

lumbar puncture (performed once stable)

Question 15

what is the rx for meningitis?

Answer 15

• abx e.g. cefotaxime (+ampicillin if risk of listeria)

- steroids in bacterial meningitis to reduce inflammation

Question 16

what do you give if you suspect meningococcal disease in primary care?

Answer 16

IM benzylpenicillin 1.2g

Question 17

CSF interpretation:-

appearance: clear
opening pressure: 10-20cm CSF
WCC: <5 cells/µL
glucose: >50% of serum
protein: <45mg/dL

dx?

Answer 17

normal

Question 18

CSF interpretation:-

appearance: cloudy/purulent
opening pressure: ↑
WCC: >100 cells/µL (neutrophils)
glucose: ↓
protein: ↑

dx?

Answer 18

bacterial

Question 19

CSF interpretation:-

appearance: clear
opening pressure: -/↑
WCC: 10-1000 cells/µL (lymphocytes)
glucose: -/↓
protein: ↑

dx?

Answer 19

viral

Question 20

CSF interpretation:-

appearance: turbid 
opening pressure: ↑
WCC: 50-500 cells/µL  (lymphocytes)
glucose: ↓
protein: ↑↑

dx?

Answer 20

TB

Question 21

what do you do for a contact of a pt with meningoccocal meningitis?

Answer 21

ciprofloxacin 500mg STAT dose

2g IM ceftriaxone if pregnant

Question 22

gram -ve diplococci on CSF gram stain. dx?

Answer 22

neisseria meningitides