sepsis

Question 1

The patient has signs of systemic inflammatory response syndrome (SIRS). What clinical signs will be present?

Answer 1

fever
hypothermia
tachycardia (HR > 90 pm)
tachypnea (> 20 breaths per minute)
hyperventilation (PaCO2 < 32mmHg)
leukocytosis - high white blood cell count

Question 2

What potential complication could put this patient at increased risk for sepsis?

Answer 2

acute dental infections = DENTAL ABCESSES
odontogenic origin = cut to gingivae during treatment while having chest infection

Question 2

how should a patient at risk of sepsis be managed?

Answer 2

REFER TO MAXFAX

antibiotics
fluids
vasopressoes
insulin therapy
oxygen therapy
lung protective ventilation
urinary catheter

Question 3

pathophysiology of SIRS

Answer 3

Immune system activation: triggers the release of pro-inflammatory CYTOKINES AND CHEMOKINES, such as interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α).

Inflammation: IL-1, IL-6 AND TNF-ALPHA cause INFLAMMATORY RESPONSE throughout the body, resulting in fever, vasodilation, increased vascular permeability, and tissue edema. These responses are intended to help the body fight the insult, but can also contribute to tissue damage and dysfunction.

Endothelial dysfunction: The inflammatory response can cause DAMAGE TO ENDOTHELIAL CELLS that line blood vessels, leading to increased vascular permeability, decreased blood flow, and impaired oxygen delivery to tissues.

Coagulation abnormalities: The activation of the immune system and endothelial dysfunction can also trigger ABNORMALITIES IN COAGULATION, resulting in disseminated intravascular coagulation (DIC), which can further contribute to tissue damage and organ dysfunction.

Organ dysfunction: The inflammatory response and associated tissue damage can lead to DYSFUNCTION OF MULTIPLE ORGANS, such as the lungs, liver, kidneys, and cardiovascular system. The severity of organ dysfunction is related to the degree of systemic inflammation and the extent of tissue damage.

Question 4

an abscess is a collection of pus that develops as a result of an acute inflammatory reaction to invading microbes. What cells and tissues compose the abscess?

Answer 4

neutrophils, macrophages, fibroblasts, granulation tissue, pus

Question 5

what are the potential consequences of an untreated dental abscess?

Answer 5

systemic inflammatory response syndrome (SIRS) that can lead to sepsis and organ dysfunction

facial bone gangrene from sepsis

Question 6

How should this patient’s abscess be treated surgically?

Answer 6

excision and drainage
periapical accesses require RCT or XLA
antibiotics are ineffective

Question 7

Assuming you have successfully treated the abscess surgically, should antibiotics be prescribed in this case? Outline the factor(s) underlying your decision whether or not to prescribe antibiotics.

Answer 7

only prescribe if there a sign of spreading infection (facial or neck swelling), systemic infection or for an immunocompromised patient

1. severity of infection
2. risk of complications
3. MH and immune status
4. antibiotic resistant patterns

Question 8

List 4 red flag signs and symptoms, which, if present would indicate the patient may be at risk of developing sepsis.

Answer 8

fever
hypothermia
tachycardia (HR > 90 pm)
tachypnea (> 20 breaths per minute)
hyperventilation (PaCO2 < 32mmHg)
varying degrees of facial swelling
trismus - muscle spasm in TMJ
dehydration
leukocytosis - high white blood cell count

Question 9

As a general dental practitioner what immediate step(s) would you take to manage a patient with diabetes presenting with a spreading dental infection plus signs and symptoms of sepsis?

Answer 9

call 999
monitor vital signs = HR, BP, respiratory rate
oxygen
get detailed MH
get ready for BLS if patient becomes unconscious