Sepsis

Question 1

How to classify septic shock

Answer 1

Severe Sepsis and Hypotension

Question 2

sepsis definition

Answer 2

ife-threatening organ dysfunction caused by dysregulated host response to infection

Question 3

If SOFA score is >2 in Sepsis what does this mean

Answer 3

Organ Dysfunction

Question 4

septic shock definition

Answer 4

can be identified with a clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP >65mmHg and having a serum lactate of >2mmol/l despite adequate volume resuscitation

Question 5

Patients with suspected infection who are likely to have a prolonged ICU stay or die in the hospital can be promptly identified with a

Answer 5

qsofa

Question 6

Q Sofa Criteria (4)

Answer 6

1. Hypotension Systolic <100
2. Altered Mental status
3. Tachypnea

Score of >2 Criteria = Great rIsk of Poor outcome

Question 7

For each hour’s delay in administering antibiotics in septic shock mortality increases by

Answer 7

7.6%

Question 8

Patients with sepsis have features consistent with immunosuppression: (3)

Answer 8

Loss of delayed hypersensitivity
Inability to clear infection
Predisposition to nosocomial infection

Question 9

Three phases in the pathogenesis of sepsis

Answer 9

Release of bacterial toxins
Release of mediators
Effects of specific excessive mediators

Question 10

Which toxins are commonly released in Sepsis Phase 1

Answer 10

Gram Neg: Lipopolysaccharide
Gram Pos: MAMP, LIpotechoic Acid
Superantigen: TSST

Question 11

What is the difference between LPS and LTA in Sepsis

Answer 11

LTA do not need LTA binding proteins to bind to Macrophages. LPS do.

Question 12

Pro Infammatory Mediators in Sepsis

Answer 12

Cause hyperthermia

Question 13

Anti-inflammatory mediators in sepsis cause (3)

Answer 13

Inhibit TNF alpha

Inhibit activation of coagulation system

Provide negative feedback mechanisms to pro-inflammatory mediators

Question 14

Organ Dysfunction Sepsis Classification (17)

Answer 14

Altered Conscious ness
Confusion
Paralysis
Tachypnoea
pA02 <70
Sats <90%
Decreased Albumin
Increased PT
Decrease Platelets
Decrease Protein C
Increase D Dimer
Tachycardia
Hypotension
Oliguria
Anuria
Increase Creatinine

Question 15

General Features of Sepsis

Answer 15

Fever >38
Hypothermia <36
Tachycardia >90 beats
Tachypnoea >20
Altered Mental State
Hyperglycaemia >8 in absence of Diabetes

Question 16

Inflammatory Variables in Sepsis (5)

Answer 16

Leucocytosis (WCC > 12,000/ml)
Leucopenia (WCC < 4,000/ml)
Normal WCC with greater than 10% immature forms
High CRP
High procalcitonin

Question 17

Haemodynamic variables in sepsis

Answer 17

Arterial hypotension (systolic <90mmHg or MAP <70mmHg)
SvO2 >70%

Question 18

Organ dysfunction variables in sepsis

Answer 18

Arterial hypoxaemia (PaO2/FiO2 < 50mmHg)
Oliguria (<0.5ml/kg/h)
Creatinine increase compared to baseline
Coagulation abnormalities (PT >1.5 or APTT >60s)
Ileus
Thrombocytopenia (<150,000/ml)
Hyperbilirubinaemia

Question 19

Tissue perfusion variables in sepsis

Answer 19

High lactate

Skin mottling and reduced capillary perfusion

Question 20

What is Septis Six

Answer 20

Oxygen
Blood Cultures
Antibiotics
Fluid Challenge
Lactate
Urine Output

Question 21

Oxygen Aim Sats in Sepsis

Answer 21

94-98%

Question 22

When to consider HDU referral in Sepsis

Answer 22

Low BP responsive to fluids
Lactate >2 despite fluid resuscitation
Elevated creatinine 
Oliguria
Liver dysfunction, Bil, PT, Plt
Bilateral infiltrates, hypoxaemia

Question 23

When to consider ITU in Sepsis

Answer 23

Septic shock
Multi-organ failure
Requires sedation, intubation and ventilation