Microbiological Emergencies - Sepsis

Question 1

Systemic inflammatory response syndrome. (SIRS)

temp?
HR?
RR?
WCC?

Answer 1

System-wide inflammation 
Clinically, you have SIRS when you have two or more of:
o	Temperature >38°C or <36°C
o	Heart rate >90bpm
o	Respiratory rate >20
o	White cell count >12

Question 2

Sepsis in relation to SIRS

Answer 2

Sepsis is SIRS due to infection. In other words, sepsis is when you have a systemic inflammatory response due to infection

Question 3

Severe sepsis

Answer 3

A form of sepsis where there is hypotension, hypoperfusion & organ dysfunction. This has a 30% mortality.

Question 4

Septic shock

Answer 4

Septic shock A form of severe sepsis that doesn’t respond to fluid therapy. This has a 60% mortality associated with it.

Question 5

• How have the definitions for sepsis changed since 2016:

They have shifted from putting emphasis on the inflammation, to putting emphasis on end-organ damage, giving you a SOFA score of 0-4.

Answer 5

The SOFA score takes into account:
o Respiratory damage (by looking at respiratory rate)
o Liver damage (by looking at bilirubin, LFTs, clotting, albumin)
o Cardiovascular damage (by looking at MAP and serum dopamine levels)
o CNS damage (by using the Glasgow coma scale)
o Renal damage (by looking at creatinine and urine output

Question 6

• Why is the new scoring system so much better?

Answer 6

Because in the very old, very young or the immunosuppressed, inflammatory responses are often very low, despite them having end-organ damage. Hence, by moving away from looking at inflammation and towards looking at organ damage, the scoring system better caters for these individuals.

Question 7

• What is a qSOFA?

Answer 7

A short version of the SOFA score which you can do without any blood tests. It only looks at respiratory rate, BP and mental status.

Question 8

• So, what is the overall new definition of sepsis regarding your SOFA score?

Answer 8

When you have a SOFA score of 2 or greater.

Question 9

• What is ‘hot’ and ‘cold’ sepsis?

Answer 9

o Initially in sepsis, there is a high cardiac output with a bounding pulse and a fever just like you would get in any other infection → hot sepsis
o As the cardiac muscle becomes affected by hypoperfusion, cardiac output falls and the patient becomes cold and clammy → cold sepsis

Question 10

Golden hour of sepsis?

Answer 10

Gold standard is to get treatment in WITHIN AN HOUR.

Any later and the hypoperfusion from the sepsis will be causing tissue damage

Question 11

SEPSIS 6

Answer 11

SEPSIS 6 – GIVE 3 TAKE 3:
Give 3: oxygen, fluid, antibiotics.
Take 3: Lactate, blood cultures, urine output