Sepsis

Question 1

What is sepsis ?

Answer 1

A life threatening dysfunction in the organs that is caused by the deranged host responding to an infection. This can lead to organ failure and death

The body fighting against itself

Question 2

Describe some signs of systematic inflammatory response syndrome (SIRS)

Answer 2

Temp - >38.3 or < 36
heart rate - >90bpm
Reps rate - >29/min
White blood count of
>1200 or < 4000

Question 3

What is septic shock ?

Answer 3

This is a subset of sepsis which profounch circulatory, cellular and metabolic abnormalities are associated with greater risk of mortality
This is a medical emergency, serious disruptive shock, caused by uncontrolled, systemic, generlised inflammation

Question 4

Describe the aetiology of sepsis

Answer 4

Any pathogen can enter the body and cause sepsis (E.g bacteria, virus, fungus)
Bacterial infections are most common when causing sepsis, the infection can come from any part of the body that is infected
The type of pathogens depend on the age, co-morbidities and geographic location
This can occur in anyone

Question 5

Which groups are at higher risk of sepsis ?

Answer 5

Children under 1 or over 75’s
Immunocompromised due to illness
Breach of the skin barrier - wounds or burns
IV patients

Question 6

Common pathogens in adults ?

Answer 6

Gram negative bacteria - E-coli, klebsilla
Gram positive bacteria - Enterococcus

Question 7

Common pathogens in children/neonatal ?

Answer 7

Gram negative Bacilli
Group B streptococci

Question 8

Explain the inflammatory response

Answer 8

Macrophages recognise pathogens and bind to then at the receptor on the membranes, this binding activates the immune cells to secrete inflammatory cytokines
Damaged cell release Histamine and Prostaglandins
These then recruit Leukocytes and Platelets from the blood to. The site of infection to eradicate it and have a clotting effect
These cause vasodilation and vascular permeability, causing fluid to spill over into the interstitial space

Question 9

What are innate immune cells ?

Answer 9

White blood cells (Neutophils + Monocytes) notice pathogens and activate the release of inflammatory medications and Cytokines

Question 10

What is the compliment system ?

Answer 10

Activation of the immune cells which help to fight infection causing more endothelial activation. These continue to produce the inflammatory meditators

Question 11

What is the coagulation system ?

Answer 11

Activation of plasma cells lead to blood clotting
In sever infection the coagulation system becomes deranged and multiple clotting factors can occur and cause intravascular coagulation

Question 12

What are endothelial cells ?

Answer 12

These contribute to vascular permeability casing fluid to cross into the interitual space. Endothelial dysfunction happens after cascade of immunology process

Question 13

What are the clinical signs of infection ?

Answer 13

Swelling
Erythmia (redness)
Pain
Lymphadenopathy
Purulent (pus)

Question 14

What are the system signs of infection ?

Answer 14

Hyperthermia
Fatigue/weakness
Headache
Leukocytosis ( increase in white blood cells)
Elevated Erythrocyte sedimentation rate (non-specific measurement of inflammation)

Question 15

Clinical features in adults

Answer 15

An infection + two fo the following:
Resp rate > 20/min
Heart rate > 90
White cell count <4 or >12
Temp <38 or >38.3

Question 16

Clinical features in children

Answer 16

Bulging fontanelle
A non-blanching rash
Decrease urine output
Reduced feeding/appetite
Hypotension
Hypoxia

Question 17

Explain the pathophysiology of clinical features of sepsis

Answer 17

Body redirects blood to vital organs because of the reduced circulatory volumes
Vasoconstriction happens peripherally meaning that there’s a prelonged capillary refill time (CRT) mottled skin and cool peripherals
As sepsis progresses this means that there is not enough tissue perfusion meaning that the body isn’t receiving enough oxygen = hypoxia
This then causes production of lactic acid which is known as metabolic acidosis
Respiratory system compensates for the metabolic acidosis and increased the respiratory rate >20
The lack of perfusion results in organ dysfunction

Question 18

Management of sepsis in CYP patients

Answer 18

1. Administer high flow oxygen
2. Gain IV access
3. Give broad range IV (Cefotaxime - 50mg/kg)
4. Supply fluids rapidly (0.9% NaCl 20ml/kg)
5. Adrenaline infusion (0.3%mg/kg in 50ml of 5% glucose)
6. Involve senior staff

Question 19

Management of sepsis in adults

Answer 19

1. Oxygen to achieve >98%
2. IV fluids (>500ml in 1 hour)
3. Blood cultures
4. IV antibiotics
5. measure lactate levels
6. Asses output (consider catheter)

Question 20

Describe the management of sepsis

Answer 20

Broad spectrum antibiotics (Amoxicillin - adults, Ceftaxime - CYP)
These are effective against gram positive and gram negative bacteria
Bloods taken to send to microbiology for gram specific testing for more effective antibiotics

Question 21

What is the mode of action for antibiotics ?

Answer 21

Inhibits cell wall synthesis
Inhibits protein synthesis
Inhibitors of nucleic acid synthesis

Question 22

What are Beta-Lactam antibiotics ?

Answer 22

Amoxicillin and Cefotaxime
Inhibiting bacterial cell wall synthesis making the bacteria cell useless and easier to eradicate
This antibiotic is given through IV

Question 23

Side effects of Beta-lactum antibiotics ?

Answer 23

Rash
Itching
Hives
Fever
Vomiting
Stomach ache
Headache
Diarrhoea

Question 24

What is inotropic therapy for sepsis ?

Answer 24

For people who done respond well to fluid resuscitation may require this treatment
Adrenaline recommended for children
Dobutamine for adults - increases the cardiac contractability and heart rate

A delay in administering this treatment increases the risk of mortality

Question 25

What is Epinephrine ?

Answer 25

An agonist (binds to receptors and activates it)
Binds to beta receptors on the heart muscle and increases the heart rate and force of contractions
Has both isotonic and chronotropic activity

Question 26

What impact on life does survival of sepsis have ?

Answer 26

Depends on the recovery and prompt management of sepsis
Early recognition and management help to avoid mortality and life changing after effects

Question 27

What long term effects can sepsis have on survivors ?

Answer 27

High risk of readmissions
Long term organ dysfunction
Cognitive impairment
Post-sepsis syndrome: physical, psychological and emotional effects
Long-term development delay
Audiology problems
Limb ischaemia