Sepsis Flashcards
Sepsis as defined by WHO is a _____________________ caused by a ____________ to infection.
life-threatening organ dysfunction
dysregulated host response
Sepsis happens when _____________ triggers ____________ throughout your body.
an infection you already have
a chain reaction
Sepsis is a serious medical condition caused by the body’s response to an infection
T/F
T
Infection:
Presence of ______ or its _______(e.g Toxins) with ________________________ to its presence.
Microbes; products
an attendant inflammatory response
Bacteremia: Presence of _______ bacteria in _________.
viable
blood
Bacteremias may be;
Transient: Organisms comprising ________ are introduced into the blood. Eg: __________,___________, manipulative procedures.
normal flora
Brushing of teeth, straining during bowel movements
Bacteremias may be;
Intermittent: Bacteria from ________ are ______________ into blood from extravascular ________, _____ cavities or diffuse infections.
Eg: Cellulitis, Peritonitis, Septic arthritis.
an infected site
spasmodically released
abscesses; empyemic
Bacteremias may be;
Continuous: Where organisms ______________________. Eg: SABE, Infected AV Fistulas, Intra arterial catheters, Indwelling cannulae.
have direct access to the bloodstream
SOME RELATED DEFINITIONS
Septicemia: Also known as __________, this is the presence of ________________ with an accompanying ___________ to its presence
blood poisoning
viable bacteria in blood
inflammatory response
SIRS (________________________________ ):
This can be defined as a _______ or _______ response to an infection manifested by _________ of some particular conditions:
Systemic inflammatory response syndrome
systemic or whole body
2 or more
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
38.5; 35.6
90
20; 32
12,000; 4,000
SEPSIS can now be more easily/accurately defined as a _________ resulting from _________.
systemic inflammatory response syndrome (SIRS)
infection
___________ + _________= Sepsis
Infection + SIRS
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
positive
negative
polymicrobial
fungi
MORTALITY RATES OF SEPSIS ACCORDING TO MICROBES
S. epidermidis- 15%
________- 20-30%
__________spp- 30%
_______spp- 40%
_____________- 50-70%
Acinetobacter spp- 50-70%
S. aureus
Enterococcus
Candida
Pseudomonas aeruginosa
MORTALITY RATES OF SEPSIS ACCORDING TO MICROBES
Gram _______ bacteria are usually more lethal.
negative
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
Community
Nosocomial
PATHOPHYSIOLOGY OF SEPSIS
• Sepsis can lead to widespread _________ and ________
inflammation and blood clotting.
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 _______
redness, heat, swelling, pain,
organ failure.
organ failure or tissue damage.
In simple terms sepsis can be viewed as an imbalance of _____,_______,______.
inflammation, coagulation, and fibrinolysis
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: _____,______,_______,________,_______
inflammatory mediators; recovery
Tumor Necrosis Factor (TNF)
Interleukins (IL)
Cytokines
Prostaglandins
Platelet Activating Factor
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.
Coagulation Cascade; a clot
fibrinolysis or breakdown.
body to destroy the bacteria; clot
neutrophils or WBCs
PATHOPHYSIOLOGY OF SEPSIS
To prevent the response from damaging normal tissue, _______ are released including __________ and _________
This balance restricts the inflammation response to the ___________
anti- inflammatory mediators
transforming growth factors and interleukins (IL-4).
local site of infection.
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.
local ; systemic
Inflammation and clotting
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
not quickly corrected
localized
critically ill ; severe sepsis
There are 3 integrated responses to sepsis
Activation of ________
Activation of ___________
Impairment of ____________
inflammation
coagulation
fibrinolysis
Activation of Inflammation
There is basically a tug of war going on between the pro-inflammatory (_____,_____,______) and anti- inflammatory components (_____,______) of the body.
IL-1,IL- 6,TNF
IL-4, IL-10
In sepsis, continued release of __________ overwhelms the ________ cytokines.
pro-inflammatory cytokines
anti- inflammatory
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.
cytokines; inflammation
thrombin
microthrombi
Inflammation and coagulation are closely linked.
T/F
T
Activation of Fibrinolysis
Fibrinolysis, or the __________, is the body’s response to the increased ______ and _________
breakdown of clots
clotting and inflammation.
Activation of Fibrinolysis
In sepsis this breakdown is inhibited or slowed because of mediators.
These mediators are called:
___________(PAI-1)
___________________________(TAFI)
Plasminogen Activator Inhibitor-1
Thrombin Activatable Fibrinolysis Inhibitor
The increased levels of these 2 inhibitors (PAI-1, TAFI) suppress _______ even more, creating a state of “ _________ ”
fibrinolysis
coagulopathy
The Role of Endothelium in Sepsis
Normal endothelium has _____coagulant abilities and plays a role in the body’s homeostasis abilities
anti
The Role of Endothelium in Sepsis
Normal endothelium homeostasis abilities including:
_________ tone
Movement of cells and nutrients
Maintaining ________.
Vasomotor; blood fluidity
When activated, endothelium also plays a role in the ______,________,_________ components of sepsis.
inflammatory, coagulation, and fibrinolytic
In sepsis the endothelium becomes damaged which makes the “inflammatory process” (better or worse?) by ______________ , thereby _______________
Worse
releasing more cytokines (TNF-a and IL-1) causing neutrophils to stick to its’ lining.
The “activation” of the capillary endothelium leads to increased _______ causing ____________ of the capillaries and into the extracellular spaces.
permeability
fluid to “leak” out
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.
Microbial infection
effects on endothelium
CLINICAL DIAGNOSIS
Can be (easy or difficult?) and needs a (low or high ?) sense of suspicion.
Difficult; high
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
two (2) or more
38.5; 35.6
90; 20
32 mm; 12,000; 4,000
CLINICAL DIAGNOSIS
Assume sepsis in the absence of any other explanation
T/F
T
Microbiology Tests
______ Culture
__________ Culture
______ Culture
Culture of ___________
Blood
Sputum
Urine
any focus of infection
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.
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
1/3rd
12; hospitalization
Blood Cultures
Quality Control
_____% Blood cultures should be contaminated.
< 3
ANTIBIOTIC TREATMENT OF SEPSIS
Eradication of the ____
_______ intervention
antimicrobial therapy
Control the ________
Protect ______
focus; surgical
inflammatory process
organ function
The final outcome of sepsis is determined in the _________
First 48-72 hours
Factors to be considered for the choice of antibiotics
___________________
The __________ of sepsis
The presence of _________
__________ or _________ in the recent past
Community versus hospital-acquired infections
anatomical site of the focus
underlying diseases
Diagnostic or surgical intervention
