FIM 9: Overview of Sepsis

Question 1

What are the non specific signs of infection?

Answer 1

High temperature
Rigors
Anorexia
Fatigue
Myalgia
Arthralgia

Question 2

What are the signs of a respiratory infection?

Answer 2

Cough, sputum, shortness of breath

Question 3

What are the signs of a urinary infection?

Answer 3

Frequency, dysuria, flank pain

Question 4

What are the signs of a skin infection?

Answer 4

Erythema, pain

Question 5

What are the signs of an abdominal infection?

Answer 5

Pain, distension

Question 6

What does SIRS stand for?

Answer 6

Systemic Inflammatory Response Syndrome

Question 7

What is SIRS?

Answer 7

The body’s response to a nonspecific insult

Eg. infection (ie. sepsis), ischaemia, haemorrhage, inflammation, trauma, burns

Question 8

What are the vital stats for someone with SIRS?

Answer 8

Temp >38 or <36
HR= 90BPM
20 breaths per min

Question 9

What is the white cell count in someone with SIRS?

Answer 9

> 12x10^9

or <4

Question 10

What is the blood glucose in someone with SIRS?

Answer 10

> 7.7 mmol/L in a non-diabetic

Question 11

Which groups have an increased mortality rate from sepsis?

Answer 11

Age extremities
Genetic polymorphisms
Co-morbidities

Question 12

What is sepsis?

Answer 12

Dysregulated host response and organ dysfunction in response to infection

Question 13

What are the haematological signs of sepsis?

Answer 13

High lactate and creatinine

Question 14

What are the non-haematological signs of sepsis?

Answer 14

Low BP
Hypoxia
Oliguria
Confusion

Question 15

What complications can arise from the release of cytokines in sepsis?

Answer 15

Cytokines stimulate coagulation and fibrinolysis

May lead to microvascular thrombosis

Question 16

What are the systemic effects of sepsis?

Answer 16

Tissue ischaemia
Cytopathic injury by cytokines
Delayed apoptosis of macrophages and neutrophils
Immunosuppression

Question 17

What result can the delayed apoptosis of macrophages and neutrophils have?

Answer 17

Prolong immune response

Leads to multiple organ failure

Question 18

Which populations are at a higher risk of getting sepsis?

Answer 18

Age extremities
Diabetics
Immunosuppressed

Question 19

What are the circulatory effects of sepsis caused by?

Answer 19

Cytokines try to increase blood flow

Question 20

What are the circulatory effects of sepsis?

Answer 20

Vasodilation
Increased permeability
Hypotension and hypoperfusion

Question 21

What effect does sepsis have on the lungs?

Answer 21

Leaky blood vessels can cause oedema which causes hypoxia due to decreased diffusion

Question 22

What effect does sepsis have on the kidneys?

Answer 22

Acute renal failure

Question 23

What effect does sepsis have on the nervous system?

Answer 23

Dysfunction of BBB

Encephalopathy

Question 24

What treatment should be given for sepsis in the first hour?

Answer 24

Take blood cultures, blood tests and urine output

Give oxygen, IV antibiotics and fluids

Question 25

What should be considered before prescribing an antibiotic?

Answer 25

Likely site of infection
Where was it acquired
Previous antibiotics
Previous infection
Allergies

Question 26

What is the most important thing to do as a junior doctor if a patient has sepsis?

Answer 26

Always refer to the consultant or critical care

Question 27

What factors cause an increased risk of sepsis in pregnancy?

Answer 27

Mother older than 35
Premature membrane rupture
Retained products
Amniocentesis
History of group B strep or pelvic infection
Contact with group A strep