S3L1 - Sepsis

Question 1

What is sepsis?

Answer 1

Life threatening condition that occurs when the body’s immune system overreacts in response to an infection, and response is unregulated, causing injury to its own tissues and organs. May result in organ dysfunction.

Question 2

What is sepsis shock?

Answer 2

Subset of sepsis where particularly profound circulatory, cellular and metabolic abnormalities substantially increase mortality.

Question 3

What are SIRS?

Answer 3

Systemic inflammatory response syndrome. Pre 2016 measurement of sepsis.

Question 4

What happens in local infection?

Answer 4

Rubor - redness
Calor - heat
Tumor - swelling
Dolor - pain

Question 5

What happens in sepsis?

Answer 5

Vasodilation - increasing blood flow and therefore immune cells being carried. This results in calor and rubor.
Permeability of blood vessels, allowing more cells to move out of the vessels into tissues. This causes swelling.
Amplification of immune cells such as phagocytes.

Question 6

Why do we need a definition for sepsis?

Answer 6

Common language and definition of sepsis helps communication between healthcare professionals as well as education of the public about the condition.
It also establishes criteria’s and thresholds beyond which interventions are recommended, therefore helps decide treatments.
Provision of criteria to determine eligibility for inclusion in a clinical trial

Question 7

How are airways affected by sepsis?

Answer 7

If infection arises from throat or neck then tumor can obstruct airway. Decreased consciousness may be at risk of airway problems.

Question 8

How does sepsis affect breathing?

Answer 8

Tachypnoea due to lung oedema decreasing lung compliance. (More fluids and proteins in the interstitial space due to vasodilation)

Question 9

How does sepsis affect a patients circulation?

Answer 9

Hypovolaemia ( fluid overload ) due to vasodilation and capillary leakage leading to hypotension. Tachycardia. End organ damage.

Question 10

How does sepsis affect disability?

Answer 10

Reduced blood flow to the brain, which may cause confusion, sleepiness, drowsiness, slurred speech, agitation, anxiety or decreased level of consciousness.

Question 11

Who is especially as risk of sepsis?

Answer 11

Very young (<1yrs)
Elderly (>75) or very frail.
Pregnant, postpartum (within last 6 weeks)
Patients with impaired immune system due to illnesses or drugs

Question 12

How is sepsis diagnosed?

Answer 12

If patient is triggering an early warning score. Looks especially ill. Has signs of infection.

Question 13

What is NEWS2?

Answer 13

Updates in 207, the NEWS2 is the national early warning score. Used in non-pregnant adults. Mandated use in all acute and ambulance settings.
Measures 6 different physiological measurements; respiration rate, oxygen saturation, systolic blood pressure, pulse rate, level of consciousness/new confusion, and temperature.

Question 14

What conditions affect NEWS2 parameters?

Answer 14

COPD lowers the oxygen saturation parameters due to decreased respiratory function.

Question 15

At what news score do we ‘think sepsis’

Answer 15

NEWS2 of 5> then think sepsis. Is not a diagnosis, just indicates clinical review if this score is abnormal/ patient is on end of life (priority would be comfort and dignity).

Question 16

What is red flag sepsis?

Answer 16

• Not a formal diagnosis
• criteria using measurements already done or easily obtainable bedside tests to identify patients with a high degree of organ dysfunction
• Patients that score a red flag have a high chance of developing sepsis.
• have different parameters to NEWS2

Question 17

How is sepsis managed?

Answer 17

Sepsis 6
- A car bundle with all 6 tasks performed together to increase the patients chance of survival if delivered in the first hour following recognition of sepsis.
Each hour delay in giving antibiotics increases mortality by 7.6%

Question 18

What 6 tasks make up the sepsis 6?

Answer 18

Give oxygen
Take cultures
Give antibiotics
Consider fluids
Take Hb and lactate (high lactate is indicative of sepsis.

Question 19

How do we test for sepsis?

Answer 19

Blood samples. Caps on bottles indicate presence or absence of aerobic bacteria as caps are sensitive to CO2 ( released during respiration). Blood culture with gram stain. Check sensitivity. Allows us to see if the microorganism is resistant or not, and therefore helps guide the antibiotics used.

Question 20

What is the tumbler test?

Answer 20

When a glass is pressed on a rash that doesn’t blanch.

Question 21

What supportive investigations can be used during sepsis?

Answer 21

Full blood count, urea and electrolytes, blood sugar, liver function tests, CRP measurement, coagulation studies, blood glucose.

Question 22

What specific investigations a can be used during sepsis?

Answer 22

Cerebrospinal fluid
Throat swab
EDTA bottle for PCR

Question 23

How is cerebral spinal fluid obtained?

Answer 23

Obtained by lumbar puncture. In a labatory, glucose and protein estimation, microscopy and culture, appearance (cloudiness and colour), microscopy of WBC and RBC, gram stain, referral to PCR used as investigations.

Question 24

What is meningococcus?

Answer 24

Neisseria meningitidus. A gram negative diplococcus, spread by aerosols and nasopharyngael secretions. Numerous serogroups. Outer membrane endotoxin.

Question 25

How do we treat meningitis?

Answer 25

Antibiotics - needs to cross blood brain barrier. Ceftriaxone first line.
Vaccination
Prophylaxis for close contacts of infected patient.