Sepsis

Question 1

risk factors for sepsis

Answer 1

-AIDS
-cytotoxic and immunosuppressive agents
-malnutrition/alcoholism
-malignancy
-diabetes
-increased age

Question 2

why has there been an increase in the number of sepsis cases

Answer 2

1. increased number of transplant recipients
2. increased use of aggressive invasive procedures in patient management and diagnosis
3. increased number of resistant organisms
4. increased number of elderly patients

Question 3

sepsis

Answer 3

life-threatening organ dysfunction caused by a dysregulated response to infection

Question 4

sequential organ failure assessment (SOFA)

Answer 4

a scoring system that assesses the performance of several organ systems in the body (neuro, blood, liver, kidney, blood pressure/hemodynamics)
*higher SOFA score = higher likelihood of mortality

Question 5

quick SOFA (qSOFA)

Answer 5

-RR > 22/min
-altered mentation
-systolic blood pressure < 100 mmHg

Question 6

septic shock (sepsis-3)

Answer 6

-a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality
-characterized by persisting hypotension and increased serum lactate

Question 7

what is responsible for the initiation of sepsis

Answer 7

signaling via TLRs, causing coagulation, cytokine production, and complement, which induce a systemic inflammatory response AND increased production of acute phase reactants

Question 8

which acute phase reactants are upregulated in inflammation

Answer 8

more FFiSH in the C
-ferritin
-fibrinogen
-serum amyloid A
-hepcidin
-C-reactive protein

Question 9

therapeutic approaches to sepsis

Answer 9

-adequate fluid administration
-antibiotics
-vasopressors (norepinephrine)
-oxygen
**need to get pathogen clearance to stop the cascade

Question 10

potential (but ineffective) therapeutic approach to sepsis: anti-LPS or anti-CD14 antibodies

Answer 10

intention: neutralize LPS or its signaling
*no overall benefit

Question 11

potential (but ineffective) therapeutic approach to sepsis: anti-TNF-alpha monoclonal antibody

Answer 11

intention: neutralize TNF-alpha
*no overall benefit

Question 12

potential (but ineffective) therapeutic approach to sepsis: nitric oxide synthase inhibitor

Answer 12

intention: prevent the production of the potent vasodilator, NO, by vascular endothelial cells
*no overall benefit