Sepsis

Question 1

What is sepsis?

Answer 1

• life threatening organ dysfunction

- due to a dysregulated host response to infection

Question 2

What are the risk factors for sepsis?

Answer 2

• extremes of age (<1 or >75)
• chronic conditions e.g. diabetes, COPD
• immunosuppressive medication / therapy
• recent survey, trauma or burns
• pregnancy and peripartum
• indwelling medical devices

Question 3

What are the sepsis 6?

or sepsis 7 for Dr Quinn

Answer 3

• Three tests:
• blood lactate level
• blood cultures
• urine output

Three treatments:

• oxygen to maintain sats 94-98% (88-92% in COPD)
• empirical broad spectrum abx
• IV fluids

7. is find the source and control it

Question 4

What is septic shock?

Answer 4

• drop in arterial BP (systolic <90mmHg)
• resulting in organ hypoperfusion
• despite adequate fluid resus
• causing hyperlactaemia (>4mmol/L)
• due to anaerobic respiration

Question 5

What bloods should you request for all patients with suspected sepsis?

Answer 5

• FBC
• U&Es
• LFTs
• CRP
• clotting screen
• blood cultures
• blood gas for lactate, pH and glucose

Question 6

What investigations may be useful to determine the source of the infection in suspected sepsis?

Answer 6

• urinalysis and culture
• CXR
• abdominal CT
• LP

Question 7

What is neutropenic sepsis?

Answer 7

sepsis in a pt with a neutrophil count <1x10^9/L

Question 8

What common types of medication may cause neutropenia?

Answer 8

• chemotherapy
• biologics for AI conditions
• DMARDs for AI conditions
• carbimazole
• quinine
• clozapine

Question 9

Treat any temperature above ___ as neutropenic sepsis, until proven otherwise, in pts taking drugs which put them at risk.

Answer 9

38

Question 10

What is the mortality rate for sepsis in the UK?

Answer 10

30%

Question 11

What are the most common causes of sepsis in the UK?

Answer 11

1. pneumonia (35%) - most common = strep pneumoniae
2. UTI (25%) - most common = e.coli
3. Intra-abdominal infection (11%) - most commonly gram negatives or anaerobes
4. Skin / soft tissue infection (11%) - most common = staph aureus

Question 12

How do you clinically identify sepsis?

Answer 12

• NEWS2 >5 OR 3 in any parameter OR gut feeling
• plausible that infection is the cause
• identify any red flags

Question 13

What are the sepsis red flags?

Answer 13

bedside indications of organ dysfunction:

• new confusion / altered mental state
• RR >25
• sysBP <90 or 20% less than normal
• sats <94% or requiring >40% O2 to maintain target sats
• oliguric or anuria for 12-18hours
• lactate >2
• coagulopathy, pupuric rash, mottled, ashen, cyanotic
• HR >130
• chemo in last 2-3 weeks

Question 14

What is the pathophysiology of DIC?

Answer 14

Disseminated Intravascular Coagulopathy

• activation of the coagulation system
• leads to deposition of fibrin
• causing platelets and clotting factors to be used up making clots
• resulting in thrombocytopenia and haemorrhages

Question 15

How does the presence of pathogens lead to tissue hypoxia in sepsis?

Answer 15

• pathogens recognised by host immune system
• host cells release cytokines
• cytokines cause vasodilation, and increase endothelial permeability
• fluid leaks out of vessels into extracellular space so the circulating volume decreases
• oedema in extracellular space increases distance for gas transfer
• coagulation system activation leads to DIC

Question 16

How should septic shock be treated?

Answer 16

• aggressive fluid resus

- escalate to intensive care with a view to using inotropes