Sepsis

Question 1

sepsis definition

Answer 1

life threatening organ dysfunction due to a dyregulated host response to infection

Question 2

bacteraemia

Answer 2

transient present of bacteria in bloodstream

Question 3

septicaemia

Answer 3

persistent presence of bacteria in the bloodstream, with attendant signs and symptoms, need to act quickly and effectively, sepsis in bloodstream

Question 4

SIRS - systemic inflammatory response syndrome

Answer 4

exaggerated defence response of the body to a stressor

Question 5

SIRS diagnosis

Answer 5

temperature >38 < 36
heart rate >90BPM
respiratory rate >20 beaths per min or PaCO2 <4.3PKa
white blood cell count >12,000 cellsmm3

Question 6

identify px at risk of sepsis

Answer 6

qSOFA - quick sequential organ failure assessment
- respiratory >=22breaths/min
- altered mentation [glasgow coma scale<15]
- systolic BP <=100mmHg

Question 7

glasgow coma scale

Answer 7

assess level of consciousness or confusion
<15 for sepsis

Question 8

aetiology of sepsis

Answer 8

infection triggers
gram-positive staph.aereus, gram negative, fungal candida
candida higher mortality compared to bacteria

Question 9

who gets sepsis

Answer 9

aging population, medically and immune-compromised
cancer, cirrhosis, autoimmunity, HIV/AIDS, organ transplantation, diabetes

Question 10

immunopathogenesis of sepsis

Answer 10

inflammatory disease
activation of innate immunity, complement system, vascular endothelium, coagulation system, adaptive immunity

Question 11

pathophysiology of sepsis

Answer 11

body wide clotting, leaky vessels, one or more organs fail, persistent hypotension

Question 12

PRRs

Answer 12

pattern recognition receptors

Question 13

pattern associated molecular patterns

Answer 13

conserved exogenous factors expressed by pathogens

Question 14

damage associated molecular patterns

Answer 14

endogenous host factors released following cell damage

Question 15

cells which express PRR

Answer 15

macrophages and epithelial cells
triggers activation of inflammatory signalling pathways

Question 16

innate immunity response to sepsis

Answer 16

cascade of chemokines, cytokines
TNFa stimulates expression of adhesion molecules and prtoeins which trigger blood clotting, recruitment of immune cells to site of infectionm prevent pathogen spreading via blood
contributes to onset of sepsis and septic shock - systemic vasodilation, increased vascular permeability, loss of BP, systemic blood clotting microvasculature
clotting = prevention of blood flow = organ failure = death

Question 17

complement system hallmark of sepsis

Answer 17

amplification of systemic inflammation, recognition of PAMPs and DAMPs
peptides C3a C5a, immunopathogeneis, amplifies inflammation

Question 18

vascular endothelium

Answer 18

changes, procoagulant state, loss of fluid and attachment of inflammatory cells, inflammatory mediators via blood, cells and proteins to leave, leaky vessels and blood clotting

Question 19

coagulation system

Answer 19

interaction between coagulation and inflammation
hypercoagulative state - fibrin depostion, microvascular thrombi, neutrophil formation, endothelial injury

Question 20

commonly affected organ systems

Answer 20

neurological [altered mental state]
pulmonary [hypoxaemia, ARDS]
cardiovascular [shock]
renal [oliguria]

Question 21

excessive inflammation

Answer 21

sustained inflammation cause tissue injury, strong activation of innate immunity via PAMPs and DAMPs, sustained hyperinflammation, activation of complemenr, coagulation and vascular endothelium

Question 22

immune suppression

Answer 22

innate and adaptive immunity, apoptosis of T cell Bcells, dysfunctional DCs, delayed apoptosis of dysfunctional neutrophuls, long term changes to immune function

Question 23

treatment of sepsis

Answer 23

early administration of antibiotics within an hour
lung protective ventilation, vasopressors, external feeding, insulin therapy, urinary cathetar, fluids

Question 24

dental abscess

Answer 24

immune response to acute bacterial infection of pulp space
contains immune cells, dead tissue, live bacteria
highly infectious
excision and drainage
periapical needs root canal/extraction
antibiotics ineffective unless widespread infection
can spread, leading to severe local and systemic consequences

Question 25

spreading dental infection signs

Answer 25

temp <36 >38
elevated breathing rate >20 breaths
elevated or reduced heart rate
varying degrees of facial swelling
trismus
dehydration