Revision - Sepsis

Question 1

What is the qSOFA score?

Answer 1

A bedside prompt that may idenitfy patients with suspected infection who are at greater risk for a poor outcome outside of ICU.

Question 2

What does the qSOFA score consist of?

Answer 2

1) RR >22

2) Altered mentation

3) Systolic BP ≤100

Question 3

What qSOFA score indicates someone at a heightened risk of mortality (10% risk)?

Answer 3

≥2

Question 4

What 2 criteria are required to diagnose septic shock?

Answer 4

1) Mean arterial pressure <65 mmHg despite fluid resus (requires vasopressors)

2) Raised serum lactate (>2 mmol/L)

Question 5

Mx of low mean arterial pressure (MAP) in septic shock?

Answer 5

Vasopressors

Question 6

Mechanism of vasopressors?

Answer 6

Cause vasoconstriction –> increase systemic vascular resistance –> increase MAP –> help tissue perfusion.

Question 7

What is the purpose of the sepsis-related (or Sequential) Organ Failure Assessment (SOFA) criteria?

Answer 7

Can be used to assess the severity of organ dysfunction, most often in the intensive care unit.

It takes into account signs of organ dysfunction:
1) Hypoxia
2) Increased oxygen requirements
3) Requiring mechanical ventilation
4) Low platelets (thrombocytopenia)
5) Reduce Glasgow Coma Scale (GCS)
6) Raised bilirubin
7) Reduce blood pressure
8) Raised creatinine

Question 8

What 6 parameters are measured in the NEWS2 score?

Answer 8

1) RR
2) HR
3) BP
4) Temp
5) O2 sats
6) Consciousness

Question 9

What is the most common bacteria causing neutropenic sepsis?

Why?

Answer 9

Staph epidermis (coagulase-negative, Gram-positive bacteria) –> probably due to indwelling lines

Question 10

What Abx is often used in neutropenic sepsis?

Answer 10

Tazocin (piperacillin + tazobactam)

Question 11

Which thyroid medication can cause neutropenia?

Answer 11

Carbimazole

Question 12

Give blood loss for the 4 classes of haemorrhagic shock

Answer 12

Class I: <750ml

Class II: 750-1500ml

Class III: 1500-2000ml

Class IV: >2000ml

Question 13

In order to generate a palpable femoral pulse, what arterial pressure is required?

Answer 13

> 65 mmHg

Question 14

How does spinal cord injury result in shock?

Answer 14

1) There is either a decrease in sympathetic tone or an increase in parasympathetic tone

2) This results in a decrease in peripheral vascular resistance mediated by marked vasodilation

3) This results in decreased preload which causes decreased cardiac output (Starling’s law)

4) There is decreased tissue perfusion –> shock

Question 15

What is the main cause of cardiogenic shock in medical patients?

Answer 15

IHD

Question 16

What is the main cause of cardiogenic shock in traumatic patients?

Answer 16

Direct myocardial trauma or contusion.

Question 17

At what age do children have similar normal vital signs to an adult?

Answer 17

> 12y/o

Question 18

What is staphylococcal toxic shock syndrome (TSS)?

Answer 18

A severe systemic reaction to staphylococcal exotoxins, the TSST-1 superantigen toxin.

Question 19

Features of TSS?

Answer 19

1) fever: temperature > 38.9ºC

2) hypotension: systolic blood pressure < 90 mmHg

3) diffuse erythematous rash

4) desquamation of rash, especially of the palms and soles

5) involvement of three or more organ systems: e.g. GI (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)

Question 20

Mx of TSS?

Answer 20

1) removal of infection focus (e.g. retained tampon)

2) IV fluids

3) IV antibiotics