Lecture 4.1: Sepsis

Question 1

What is Sepsis?

Answer 1

Sepsis is a syndrome defined as life-threatening organ dysfunction due to a dysregulated host response to infection

Question 2

What is Septic Shock?

Answer 2

It is a subset of Sepsis where particularly profound circulatory, cellular and metabolic abnormalities significantly increase mortality

Question 3

In Sepsis the Inflammatory Response goes wrong, what changes occur?

Answer 3

• Vasodilation
• Increased vascular permeability
• Pro-inflammatory cytokines damage the vascular endothelium - ‘capillary leak
syndrome’
• =>Reduced peripheral vascular resistance
• =>Relative hypovolaemia

Question 4

What happens to BP and Heart Rate during Sepsis?

Answer 4

• Reduced BP

* Compensatory Tachycardia

Question 5

Myocardial Dysfunction: How are CO levels maintained during early Sepsis?

Answer 5

CO is maintained via an increase in HR and myocardial contractility and a
‘hyperdynamic circulation’ is seen

Question 6

What is Hyperdynamic Circulation?

Answer 6

It is is abnormally increased circulatory volume

Question 7

Myocardial Dysfunction: What happens when HR further increases?

Answer 7

• Reduced Cardiac Filling
• Reduced Coronary Perfusion Time
• Results in reduced CO
• Results in Myocardial Ischaemia

Question 8

Myocardial Dysfunction: What happens in the later stages of Sepsis?

Answer 8

Pro-inflammatory cytokines + hypoxia and acidosis, directly impair myocardial contractility, reducing CO further

Question 9

What causes Sepsis- the Pathophysiology?

Answer 9

Immune Response

Coagulation Cascade

Question 10

Effects of Sepsis on Lungs (5)

Answer 10

• Tachypnoea
• Rapid breathing
• Shortness of breath
• Difficulty taking breaths
• Acute Respiratory Distress Syndrome (ARDS)

Question 11

Effects of Sepsis on Tissues? (4)

Answer 11

• Anaerobic respiration in tissues
• Decreased pH
• Metabolic Acidosis
• Imcreased Respiratory Rate

Question 12

Effects of Sepsis on the Renal System? (2)

Answer 12

• Reduced renal blood flow

* Reduced urine output

Question 13

Effects of Sepsis on the Brain? (4)

Answer 13

• Confusion
• Raised blood sugar
• Increased gluconeogenesis inhibits ability of peripheral tissues to uptake 
  glucose
• C-reactive protein found

Question 14

Effects of Sepsis on Coagulation in the body?

Answer 14

• Pro-inflammatory cytokines damage the vascular endothelium

* Leads to widespread activation of the coagulation system and clot formation

Question 15

What is Purpura?

Answer 15

Purple-colored spots and patches that occur on the skin, and in mucus membranes, including the lining of the mouth caused when small blood vessels leak blood under your skin’s surface

It is not a medical condition itself, rather a sign of an underlying one

Question 16

Signs of Sepsis: TIME

Answer 16

T: Temperature
I: Infection
M: Mental Decline
E: Extremely Ill

Question 17

Symptoms of Sepsis in Children (6)

Answer 17

• Tachypnoea
• Having a ‘fit’ or convulsions
• Mottled, bluish, pale skin
• Has a non-blanching rash
• Lethargy/ not able to wake properly
• Feels abnormally cold to touch

Question 18

Symptoms of Sepsis in Adults: SEPSIS

Answer 18

S: Slurred Speech/ Confusion
E: Extreme Shivering/ Muscle Pain
P: Passing no Urine (in 1 day)
S: Severe Breathlessness 
I: It feels like you're going to die
S: Skin mottled or discoloured

Question 19

Who is at risk of Sepsis? (7)

Answer 19

• People with Chronic Conditions
• Elderly People (65+)
• Young Children (below 1)
• Immunocompromised People
• Sepsis Survivors
• People with Recent Severe Illness
• People Recently Hospitalised

Question 20

National Early Warning Score (NEWS) (6)

Answer 20

• Respiration
• Oxygen Saturation
• Temperature
• Systolic BP
• Pulse Rate
• Level of Consciousness

Question 21

Managing Sepsis: The Sepsis 6

Answer 21

1) Give O2 if required
2) Give Antibiotics
3) Give IV Fluids
4) Take blood culture
5) Take urine output
6) Take lactate measurements