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MBBS 3: Internal Medicine > Sepsis > Flashcards

Sepsis Flashcards

1
Q

What is sepsis?

A

is caused when the body’s immune system becomes overactive in response to an infection, causing an exagerrated inflammation which causes body tissue damage

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2
Q

Criteria for systemic inflammatory response syndrome (SIRS)?

A
  1. HR>90
  2. RR>20
  3. T > 38 degrees or < 36 degrees celsius
  4. Abnormal WBC count > 12,000 or < 4,000
  5. Band cells > 10%
  6. Low pCO2
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3
Q

Sepsis and SIRS?

A

2 SIRS criteria + Infection

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4
Q

Criteria for severe sepsis?

A
  1. Hypotension
    - systolic BP less than or equal to 90 or MAP of less than or equal to 70.
  2. End organ damage
  3. Elevated lactic acidosis
  4. Thrombocytopenia
    - Platelets of less than 80 thousand
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5
Q

Septic shock?

A
  • Severe sepsis and persistent signs of end organ dysfunction
  • Mortality 50%
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6
Q

Normal response to infection?

A

non-specific inflammatory response to local infection that happens in 3 phases

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7
Q

3 phases of normal response to infection?

A
  1. Vasodilation - increased blood flow to site, infusion of antibodies and cells to fight infection
  2. Vessel permeability - antibodies and cells exit bloodstream and enter infected tissue
  3. Once infection is controlled, tissue repairs itself
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8
Q

Pathophysiology of sepsis?

A
  1. Uncontrolled, exaggerated immune response
  2. Endothelium damage, cell mediator activation, disruption of coagulation system homeostasis
  3. Vasodilation and capillary permeability
  4. Systemic inflammatory response
  5. End-organ damage, death
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9
Q

What is qSOFA?

A

quick sequential organ failure assessment score

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10
Q

What is the scoring of qSOFA?

A

The quick SOFA (qSOFA) score, includes 1 point for each of 3 criteria
1. respiratory rate ≥ 22 breaths/min
2. altered mental status, or
3. systolic blood pressure (SBP) ≤ 100 mm Hg
- A qSOFA score ≥ 2 is suggestive of sepsis and warrants treatment instantly

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11
Q

The infectious causes of sepsis?

A
  1. bacteria
  2. fungi
  3. parasites
  4. other
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12
Q

SIRS triggers?

A
  1. pancreatitis
  2. burns
  3. trauma
  4. other
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13
Q

Risk factors for sepsis?

A
  1. Extremes of age (old and young)
  2. Recent surgery, invasive procedure, illness, childbirth/pregnancy termination/miscarriage
  3. Immunosuppression
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14
Q

What extremes of age are risk factors for sepsis?

A
  1. Can’t communicate, need careful assessment
  2. Patients with developmental delay
  3. Cerebral Palsy
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15
Q

Diseases that increase the risk for sepsis?

A
  1. Diabetes
  2. Liver cirrhosis
  3. Autoimmune diseases (lupus, rheumatoid arthritis)
  4. HIV/AIDS
  5. Para/quadriplegics
  6. Sickle cell disease
  7. Splenectomy patients
  8. Compromised skin (chronic wounds, burns, ulcers
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16
Q

Drugs that cause an increased risk for sepsis?

A
  1. Chemotherapy
  2. Post-organ transplant (bone marrow, solid organ)
  3. Chronic steroid use
  4. Recent antibiotic use
  5. Indwelling catheters of any kind (dialysis, Foley, IV, etc)
17
Q

Signs and symptoms for sepsis?

A
  1. Fever = most common (elderly and severely immunosuppressed patients may NOT mount a febrile response)
  2. Flu-like symptoms
  3. Chills/shaking (mistaken for seizure)
  4. Nausea/vomiting
  5. Mental status
  6. changes/fatigue/lethargy
18
Q

Potential sources of infection?

A
  1. Pneumonia
  2. Skin infection – cellulitis, wounds
  3. Infection after abdominal surgery
  4. Urinary tract infection
  5. IV drug use infections
  6. Pressure sores
19
Q

Investigations in sepsis?

A
  1. Culture
    - blood, urine, pus swab, sputum
  2. Full blood count
  3. Urea and creatinine& electrolytes
  4. Lumber puncture
  5. HIV tests, CD4 count, viral load
  6. Radiological
    - CXR, USS, ECHO, CT, MRI
  7. Serum lactate
  8. Blood glucose
20
Q

Treatment of sepsis?

A
  1. IV fluids, crystolloids, albumin,
  2. Broad spectrum antibiotics within one hour of recognition until definitive culture results
  3. Oxygen if ARDS or O2 stats below 92
21
Q

Inotropes treatment of sepsis?

A
  1. epinephrine
  2. vasopressin
  3. Dopamine
22
Q

Supportive treatment of sepsis?

A
  1. ICU care
    - ventilation, plone positioning in ARDS
  2. Renal replacement for renal complications
  3. Glucose control
  4. Venous thromboembolic prophylaxis
23
Q

What is neutropenic sepsis?

A

Common in cancer patients as a consequence of chemotherapy or direct effect of malignancies on the bone marrow (suppression)
Note: Can also be a consequence of any other causes of severe neutropenia

24
Q

Definition of severe neutropenia?

A

Severe neutropenia is defined as an absolute neutrophil count of less than 0.5x10^9

25
Q

When does neutropenic sepsis occur?

A

Neutropenic sepsis commonly occurs 7-14 days after starting chemotherapy

26
Q

When to consider a neutropenic sepsis diagnosis?

A

in a patient on anti-cancer drugs with a neutrophil count of 0.5x10^9 with:
1. Temp 38 degrees celcius
2. signs and symptoms of sepsis

27
Q

Pathogen that causes neutropenic sepsis?

A
  1. Coagulase-negative
  2. gram positive cocci are the commonest cause
    - particularly staphylococcus epidermidis
    Note: this is usually due to use of indwelling lines
28
Q

Prophylaxis for a neutropenic patient?

A

Fluoloquinolones

29
Q

Treatment of neutropenic sepsis?

A

Antibiotics must be started empirically and immediately
- do not wait for FBC results!
1. Piperacirin with tazobactam (Tazocin) a broad spectrum antibiotic combination.
2. Vancomycin can also be added if a patient has central venous lines
3. meropenem with or without vancomycin
- if still febrile and unwell after 48 hours of initial antibiotics

30
Q

What do you do if you have no response after 4-6 days of treatment of neutropenic sepsis?

A

If no response after 4-6 days investigate for fungal sepsis and treat accordingly
- Consider G-CSF (granulocyte colony stimulating factor).

MBBS 3: Internal Medicine (72 decks)

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