Lecture 3.1 - Sepsis

Question 1

When/why does SIRS occur?

Answer 1

SIRS is a response to a non-specific insult. It occurs when homeostasis is not restored following cytokine release into the circulation

Question 2

What are the clinical features of SIRS?

Answer 2

Must have 2 or more of the following:

• Temperature 38
• HR >90
• RR > 20
• WBCs 12x10^9

Question 3

What are the various levels on the sepsis pathway?

Answer 3

SIRS
Sepsis
Severe sepsis
Septic shock

Question 4

What is sepsis, and how can it be defined?

Answer 4

Sepsis is the systemic response to infection

Can be defined as SIRS + presumed/documented infection

Question 5

Define severe sepsis

How does this translate clinically?

Answer 5

Severe sepsis = SIRS + organ dysfunction or hypoperfusion

Translates as SIRS with low BP and/or decreased urine output

Question 6

Define septic shock

Answer 6

SIRS + persistently low BP despite IV fluids

Question 7

How does sepsis lead to ischaemia and hence organ dysfunction?

Answer 7

Initial insult leads to cytokine release. These initiate thrombin production, promoting clotting. The coagulation cascade leads to microvascular thrombosis and hence ischaemia.

Question 8

What is the “sepsis 6” in broad terms?

Answer 8

Group of 6 tests/treatments that must be performed within an hour of a patient presenting with sepsis

Question 9

What is included in the sepsis 6?

Answer 9

• Oxygen
• IV fluids
• IV antibiotics (preferably specific)
• Serum lactate measurement
• Blood cultures
• Urine output measurement

Question 10

What does SIRS stand for?

Answer 10

Systemic Inflammatory Response Syndrome