Sepsis

Question 1

Sepsis as defined by WHO is a _____________________ caused by a ____________ to infection.

Answer 1

life-threatening organ dysfunction

dysregulated host response

Question 2

Sepsis happens when _____________ triggers ____________ throughout your body.

Answer 2

an infection you already have

a chain reaction

Question 3

Sepsis is a serious medical condition caused by the body’s response to an infection

T/F

Answer 3

T

Question 4

Infection:

Presence of ______ or its _______(e.g Toxins) with ________________________ to its presence.

Answer 4

Microbes; products

an attendant inflammatory response

Question 5

Bacteremia: Presence of _______ bacteria in _________.

Answer 5

viable

blood

Question 6

Bacteremias may be;

Transient: Organisms comprising ________ are introduced into the blood. Eg: __________,___________, manipulative procedures.

Answer 6

normal flora

Brushing of teeth, straining during bowel movements

Question 7

Bacteremias may be;

Intermittent: Bacteria from ________ are ______________ into blood from extravascular ________, _____ cavities or diffuse infections.

Eg: Cellulitis, Peritonitis, Septic arthritis.

Answer 7

an infected site

spasmodically released

abscesses; empyemic

Question 8

Bacteremias may be;

Continuous: Where organisms ______________________. Eg: SABE, Infected AV Fistulas, Intra arterial catheters, Indwelling cannulae.

Answer 8

have direct access to the bloodstream

Question 9

SOME RELATED DEFINITIONS

Septicemia: Also known as __________, this is the presence of ________________ with an accompanying ___________ to its presence

Answer 9

blood poisoning

viable bacteria in blood

inflammatory response

Question 10

SIRS (________________________________ ):

This can be defined as a _______ or _______ response to an infection manifested by _________ of some particular conditions:

Answer 10

Systemic inflammatory response syndrome

systemic or whole body

2 or more

Question 11

SIRS:

Temperature above ______oC or below ______oC

Heart rate above _____ beats per minute
Respiratory rate above ____ per minute

PaCO2 below _____mm Hg

White blood cell count above ______uL or below _____uL

Answer 11

38.5; 35.6

90

20; 32

12,000; 4,000

Question 12

SEPSIS can now be more easily/accurately defined as a _________ resulting from _________.

Answer 12

systemic inflammatory response syndrome (SIRS)

infection

Question 13

___________ + _________= Sepsis

Answer 13

Infection + SIRS

Question 14

AETIOLOGY OF SEPSIS

Sepsis is caused by infection. Of cases with positive blood cultures,

40% -gram-________bacteria
35% - gram-______ bacteria
11% - __________
7% -______
<5% - classic pathogens

Answer 14

positive

negative

polymicrobial

fungi

Question 15

MORTALITY RATES OF SEPSIS ACCORDING TO MICROBES

S. epidermidis- 15%
________- 20-30%
__________spp- 30%
_______spp- 40%
_____________- 50-70%

Acinetobacter spp- 50-70%

Answer 15

S. aureus

Enterococcus

Candida

Pseudomonas aeruginosa

Question 16

MORTALITY RATES OF SEPSIS ACCORDING TO MICROBES

Gram _______ bacteria are usually more lethal.

Answer 16

negative

Question 17

WHAT CAUSES SEPSIS?
Sepsis infections can be divided into two:

_________ acquired infections:
Gram-positive bacteria: S. pyogenes, S. pneumoniae, S. aureus Gram-negative bacteria: E. coli, N. meningitidis, L. pneumophila

____________ infections:
Gram-positive bacteria: S. aureus (MRSA), S. epidermidis (MRSE), Enterococcus spp Gram-negative bacteria: E. coli, K. pneumoniae, P. aeruginosa, Acinetobacter baumannii Fungi: Candida spp, Aspergillus spp

Answer 17

Community

Nosocomial

Question 18

PATHOPHYSIOLOGY OF SEPSIS

• Sepsis can lead to widespread _________ and ________

Answer 18

inflammation and blood clotting.

Question 19

PATHOPHYSIOLOGY OF SEPSIS

• Inflammation may result in _____,______,_____,_______ and ______

• Blood clotting during sepsis causes reduced blood flow to limbs and vital organs, and can lead to ________ or _______

Answer 19

redness, heat, swelling, pain,

organ failure.

organ failure or tissue damage.

Question 20

In simple terms sepsis can be viewed as an imbalance of _____,_______,______.

Answer 20

inflammation, coagulation, and fibrinolysis

Question 21

PATHOPHYSIOLOGY OF SEPSIS

During a normal response to bacteria in the blood, the immune system releases ___________ to promote ______ of the tissue.

These mediators are known as: _____,______,_______,________,_______

Answer 21

inflammatory mediators; recovery

Tumor Necrosis Factor (TNF)
Interleukins (IL)
Cytokines
Prostaglandins
Platelet Activating Factor

Question 22

PATHOPHYSIOLOGY OF SEPSIS

The release of the inflammatory mediators starts the ________ leading to the development of ______

To maintain this , inhibitors are released to suppress _______ or _______

This is necessary to have time for the _____________________ before the ____ is gone.

Once the bacteria or antigen is isolated, the pro-inflammatory mediators attract ______ or ____ which attack the antigen and try to engulf it.

Answer 22

Coagulation Cascade; a clot

fibrinolysis or breakdown.

body to destroy the bacteria; clot

neutrophils or WBCs

Question 23

PATHOPHYSIOLOGY OF SEPSIS

To prevent the response from damaging normal tissue, _______ are released including __________ and _________

This balance restricts the inflammation response to the ___________

Answer 23

anti- inflammatory mediators

transforming growth factors and interleukins (IL-4).

local site of infection.

Question 24

PATHOPHYSIOLOGY OF SEPSIS

This balance of inflammatory and anti- inflammatory mediators

When the body is unable to maintain the appropriate balance, the immune response is no longer ______ but becomes _______.

________ and altered ______ quickly spread through the body.

Answer 24

local ; systemic

Inflammation and clotting

Question 25

In spesis If this inflammatory process is ________________, the person with the infection which was once _______ could become ___________ and move into ____________ with a high probability of Death

Answer 25

not quickly corrected localized critically ill ; severe sepsis

Question 26

There are 3 integrated responses to sepsis Activation of ________ Activation of ___________ Impairment of ____________

Answer 26

inflammation coagulation fibrinolysis

Question 27

Activation of Inflammation There is basically a tug of war going on between the pro-inflammatory (_____,_____,______) and anti- inflammatory components (_____,______) of the body.

Answer 27

IL-1,IL- 6,TNF IL-4, IL-10

Question 28

In sepsis, continued release of __________ overwhelms the ________ cytokines.

Answer 28

pro-inflammatory cytokines anti- inflammatory

Question 29

Activation of Coagulation The _______ from _______ stimulate coagulation pathways. This results in the forming of the enzyme _______. This produces clotting in the body. The enhanced clotting continues making tiny clots or “ ________ ” in the vascular system which impairs blood flow and organ perfusion.

Answer 29

cytokines; inflammation thrombin microthrombi

Question 30

Inflammation and coagulation are closely linked. T/F

Answer 30

T

Question 31

Activation of Fibrinolysis Fibrinolysis, or the __________, is the body’s response to the increased ______ and _________

Answer 31

breakdown of clots clotting and inflammation.

Question 32

Activation of Fibrinolysis In sepsis this breakdown is inhibited or slowed because of mediators. These mediators are called: ___________(PAI-1) ___________________________(TAFI)

Answer 32

Plasminogen Activator Inhibitor-1 Thrombin Activatable Fibrinolysis Inhibitor

Question 33

The increased levels of these 2 inhibitors (PAI-1, TAFI) suppress _______ even more, creating a state of “ _________ ”

Answer 33

fibrinolysis coagulopathy

Question 34

The Role of Endothelium in Sepsis Normal endothelium has _____coagulant abilities and plays a role in the body’s homeostasis abilities

Answer 34

anti

Question 35

The Role of Endothelium in Sepsis Normal endothelium homeostasis abilities including: _________ tone Movement of cells and nutrients Maintaining ________.

Answer 35

Vasomotor; blood fluidity

Question 36

When activated, endothelium also plays a role in the ______,________,_________ components of sepsis.

Answer 36

inflammatory, coagulation, and fibrinolytic

Question 37

In sepsis the endothelium becomes damaged which makes the “inflammatory process” (better or worse?) by ______________ , thereby _______________

Answer 37

Worse releasing more cytokines (TNF-a and IL-1) causing neutrophils to stick to its’ lining.

Question 38

The “activation” of the capillary endothelium leads to increased _______ causing ____________ of the capillaries and into the extracellular spaces.

Answer 38

permeability fluid to “leak” out

Question 39

In a nutshell; As a result of ________: The imbalance of Inflammation, coagulation, and Fibrinolysis and the ___________ can lead to organ failure, even death if led undetected or untreated.

Answer 39

Microbial infection effects on endothelium

Question 40

CLINICAL DIAGNOSIS Can be (easy or difficult?) and needs a (low or high ?) sense of suspicion.

Answer 40

Difficult; high

Question 41

CLINICAL DIAGNOSIS A systemic or whole body response to an infection manifested by ————— of the following conditions: Temperature above ____oC or below ______oC Heart rate above _____ beats per minute Respiratory rate above ___ per minute or PaCO2 below ______ Hg White blood cell count above ______uL or below ______uL

Answer 41

two (2) or more 38.5; 35.6 90; 20 32 mm; 12,000; 4,000

Question 42

CLINICAL DIAGNOSIS Assume sepsis in the absence of any other explanation T/F

Answer 42

T

Question 43

Microbiology Tests ______ Culture __________ Culture ______ Culture Culture of ___________

Answer 43

Blood Sputum Urine any focus of infection

Question 44

Blood Cultures Source of Organism not determined in 1/3rd of cases. Patients with positive blood cultures were 12 times more likely to die during hospitalization than those with negative blood Quality Control < 3% Blood cultures should be contaminated.

Question 45

Blood Cultures Source of Organism not determined in ______ of cases. Patients with positive blood cultures were _____ times more likely to die during ________ than those with negative blood

Answer 45

1/3rd 12; hospitalization

Question 46

Blood Cultures Quality Control _____% Blood cultures should be contaminated.

Answer 46

< 3

Question 47

ANTIBIOTIC TREATMENT OF SEPSIS Eradication of the ____ _______ intervention antimicrobial therapy Control the ________ Protect ______

Answer 47

focus; surgical inflammatory process organ function

Question 48

The final outcome of sepsis is determined in the _________

Answer 48

First 48-72 hours

Question 49

Factors to be considered for the choice of antibiotics ___________________ The __________ of sepsis The presence of _________ __________ or _________ in the recent past

Answer 49

Community versus hospital-acquired infections anatomical site of the focus underlying diseases Diagnostic or surgical intervention