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MD3001 - Cardiology Disease and Pathology > Pathophysiology and Treatment of Sepsis > Flashcards

Pathophysiology and Treatment of Sepsis Flashcards

1
Q

What is sepsis?

A

Life-threatening oragn dysfunction caused by a dysregulated host response to infection

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2
Q

What is septic shock?

A

A subset of sepsis in which particularly profound circulatory, cellular and metabolic abnormalities are associated with greater risk of mortality

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3
Q

Who is at risk of sepsis?

A
  • Very young and very old
  • impaired immune system
  • surgery in the last 6 weeks
  • breach of skin integrity
  • misuse of IV drugs
  • indwelling lines or catheters
  • Women who are pregnant, given birth or had a termination or miscarriage in the last 6 weeks
  • Neonates
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4
Q

What is sepsis caused by?

A

ANYTHING

  • Respiratory
  • Abdomen
  • Bloodstream
  • skin
  • urinary system
  • UNKNOWN
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5
Q

what are the 9 key causative pathogens associated with sepsis?

A
  • Neisseria meningitidis
  • Streptococcus pneumoniae
  • Streptococcus pyogenes
  • Staphylococcus aureus (including MRSA)
  • Salmonella typhimurium
  • Klebsiella pneumoniae
  • Gram negative bacilli
  • Candida species
  • Asplenics are at risk of infection by encapsulated organisms
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6
Q

Breaches of Host barrier integrity

A
  • physical barriers
    • skin
    • mucous membranes
  • Breaches may be obvious:
    • catheters
    • wounds
    • burns
    • thorn pricks
    • bites
  • Breaches may be more subtle - epithelial cell damage
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7
Q

What are the 5 main factors affecting infection?

A
  1. virulence of organism
  2. bioburden
  3. portal of entry
  4. host susceptibility
  5. temporal evolution
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8
Q

What is the first line of defence against pathogen insult?

A

host innate immunity

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9
Q

What are the main aspects of the host innate immunity?

A
  • Complement cascade
  • Mannose-binding lectin
  • Phagocytes
  • Toll-like receptors (TLRs)
  • Nucleotide binding oligomerisation domain receptors (NLRs)
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10
Q

What are the main inflammatory markers initiated by the host innate immune system?

A
  • Interlukins
  • Tumour necrosis factor alpha
  • Reactive oxygen species
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11
Q

What does TLR4 recognise and what can this recognise

A

LPS

Present in all gram negative bacteria

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12
Q

What are the effects of TNFalpha and IL-1 on the CVS?

A
  • Generalised vasodilation (NO)
  • Increased vascular permeability (activated leukocytes) - bradykinin and histamine release
  • Intravascular fluid loss
  • myocardial depression (tissue hypoxia)
  • circulatory shock
  • cytokine causes mast cells to degranulate
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13
Q
A
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14
Q

What occurs in acute phase response

A
  • Fever
  • Hypotension
  • Increased HR
  • Corticosteriod and ACHT release
  • Released of neutrophils
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15
Q

Who to screen for sepsis?

A
  • Presents with unexplained illness
  • Look unwell and has a likely infective cause OR presents with a parameter score or aggregate score of 4 or higher on NEWS
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16
Q

What are the symptoms of systemic inflammatory response syndrome?

A
  • Fever (>38) or hypothermia (<36)
  • Tachycardia
  • Tachypnooea (>20)
  • Leucocytosis
17
Q

What should be checked prior to carrying out the sepsis six?

A
  • ABC
18
Q

What is the sepsis six (BUFALO)

A
  1. Blood cultures
  2. Urine output
  3. IV fluids
  4. Broad spectrum antibiotics
  5. Lactate and haemoglobin
  6. High flow Oxygen
19
Q

What should be given in a respiratory infection?

A

broad spectrum and consider pseudamonas or MRSA

20
Q

What should be given in a urinary infection?

A

gram negative and pseudamonas

21
Q

What should be given in a abdominal infection?

A

gram negtaive/positive anerobes

22
Q

What should be given in a soft tissue infection?

A

Gram negtaive/positive and anerobes

23
Q

What should be given in a CNS infection?

A

menigitis

24
Q

What antibiotics is given if meningococcal disease is suspected?

A

IV/IM benzylpenicillin or cefotaxime

25
Q

Short term complications of sepsis

A

organ dysfunction and coagulation disorders

26
Q

long term complications of sepsis

A

neurlogical dysfunction, increased mortality rate for at least a year

MD3001 - Cardiology Disease and Pathology (10 decks)

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