ID

Question 1

which classes of antibiotic have a beta-lactam ring?

Answer 1

penicillins
carbapenems
cephalosporins

Question 2

stepwise approach to picking ABx in hospital?

Answer 2

-start empirically with amoxicillin (covers streptococcus, listeria and enterococcus)

-switch to co-amoxiclav (all of above plus staphylococcus, haemophilus and e. coli)
-switch to tazocin (plus pseudomonas)
-switch to meropenem (plus ESBLs)
add on teicoplanin / vancomycin (covers MRSA)
-add clarithromycin / doxycycline (covers atypical bacteria)

Question 3

pathophysiology of sepsis?

Answer 3

-cytokines trigger a huge immune response
-nitrous oxide gives vasodilation
-coagulation system gets activated, causes DIC
-hypoxia occurs, causing anaerobic respiration and blood lactate rises

Question 4

what are the 2 ways in which septic shock can be defined?

Answer 4

either of these:

-systolic BP <90 despite fluid resus
-lactate >4 mmol/l

Question 5

management of septic shock?

Answer 5

-aggressive fluid resus
-ICU admission
-inotropes (noradrenalin)

Question 6

features of severe sepsis?

Answer 6

-hypoxaemia
-oliguria
-AKI
-thrombocytopenia
-coagulation dysfunction
-hypotension
-lactate >2 mmol/l

Question 7

risk factors for sepsis?

Answer 7

-extremes of age
-chronic disease (e.g. COPD, DM)
-surgery
-recent trauma / burns
-pregnancy / peripartum
-indwelling catheter / central line

Question 8

which signs make up the NEWS?

Answer 8

temp
HR
RR
O2
BP
GCS

Question 9

sign o/e in sepsis

Answer 9

-signs of source of infection (cellulitis, wound discharge, cough, dysuria)
-non-blanching rash
-reduced UO
-mottled skin
-cyanosis
-arrhythmias (e.g. new AF)

Question 10

what is often the first sign of sepsis?

Answer 10

high RR (tachypnoea)

Question 11

how might elderly patients present with sepsis?

Answer 11

-confused
-drowsy
-“off legs”

Question 12

which pts might have normal obs even if they are severely septic?

Answer 12

neutropenic pts

• immunosuppressed pts

Question 13

investigations for sepsis?

Answer 13

a bunch of bloods:

FBC
UEs
LFTs
CRP
clotting (DIC)
blood cultures
blood gas (lactate)

Question 14

which additional, non-blood test investigations can be helpful in sepsis?

Answer 14

urine dip and culture
CXR
CT (look for source of infection)
LP (if meningitis / encephalitis)

Question 15

Sepsis 6

Answer 15

3 in:
oxygen (>94%)
IV abx
fluids

3 out:
lactate
bl culture
urine - catheter