ID Exam 2: Sepsis

Question 1

Steps to sepsis

Answer 1

1˚ mediators: IL-1, TNF-a, ROS, RNS, lipids
2˚ mediators: NO, PAF, PG, LT, IL, Kinins
Cycle of hypoperfusion
MODS
Death

Question 2

Basic mech of sepsis and levels of immune activation

Answer 2

Bacteria more like bystanders
Shammbled immune response
Young healthy: robust immune response, sometimes needs steroids, brief hypo-immune phase
Elderly: some response, longer hypo-immune phase
Comorbid ESRD: little response, prolonged phase

Question 3

Organisms in sepsis

Answer 3

Majority are gram-
Many are still gram+
1/3 of patients using current techniques can’t determine bacterial cause

Question 4

Non-infectious mimics of sepsis

Answer 4

7 A's
Acute MI
Acute PE
Acute pancreatitis
Acute GI bleed
Adverse drug rxns
Accidents (trauma)
Ablase: burns

Question 5

Site of infections

Answer 5

Respiratory most common for site

Top 3 mortality: bactermia, endocarditis, respiratory

Question 6

Early cellular/molecular events during infection

Answer 6

1. Vasodiliation and endothelial activation
2. Leukocyte recruitment and activation
3. Coagulation and NET formation

Question 7

Molecular pathogenesis

Early vs. late

Answer 7

Mitochondrial cytopathic hypoxia

Hypo-immune state

Question 8

SIRS now outdated (4 criteria?)

qSOFA components

Answer 8

SIRS: WBC, fever (or low), RR, HR
qSOFA: AMS, RR, BP

Question 9

Sepsis treatment bundle

Answer 9

1. Screen
2. Blood/resp cx.
3. Broad abx
4. IV fluids
5. Normalize lactate
6. Pressors