sepsis

Question 1

define sepsis

Answer 1

Life threatening organ dysfunction caused by a dysregulated host response to infection

Question 2

is sepsis considered infection?

Answer 2

it is NOT an infection, it is only triggered by infection

it is fundamentally an inflammatory disease

Question 3

qSOFA 3 criteria
- respi
- GCS
- BP

Answer 3

quick sepsis related organ failure assesment

• Respiratory > 22 breaths per minute
• Altered mental status from baseline of 0; Glasgow coma scale <15
• Systolic blood pressure < 100mmHg

Question 4

What causes sepsis

Answer 4

• Infection
• Bacteria
  o S aureus
• Fungal
  o Candida

Question 5

Which organ does sepsis usually appear?

Answer 5

• Lungs
• Abdomen
• Bloodstream
• Urinary system

Question 6

who is at risk of sepsis

Answer 6

• Aging population
• Immunocompromised patients

Question 7

what is the pathophysiology of sepsis? 4 points

Answer 7

1 body wide clotting

2 leaky vessels, vasodilation

3 organ failure

4 persistent hypotension, fluids cannot be maintained within vessels

Question 8

immunopathogenesis of sepsis

5 categories

Answer 8

1 innate immunity
2 complement system
3 vascular endothelium
4 coagulation system
5 adaptive immunity

Question 9

how to treat sepsis

Answer 9

• Systemic Antibiotics
• Vasopressor
• Fluids
• Insulin therapy
• Lung ventilation
• Urinary catheter

Question 10

Describe the local and potential systemic consequences of dental abscesses with ref to appropriate antibiotic use

Answer 10

Acute dental infections can cause sepsis
o Abscesses
o Odontogenic
o Perio
o Caries
o Any infection really

Question 11

how do dental abscesses form

Answer 11

• Immune response to acute bacterial infection of pulp space

Question 12

What do dental abscesses contain?

Answer 12

• Immune cells
• Dead tissues
• Live bacteria

Question 13

2 keys factors making dental abscesses risk for sepsis

Answer 13

1. Highly infectious
2. Can spread easily, leading to local and systemic consequences

Question 14

what other anatomical regions are closely related to the teeth

Answer 14

a. Nasal passages, maxillary sinus, Mylohyoid muscle, Buccinator muscles, oral cavity, tongue, orbit etc

potential for spread of dental abscess

Question 15

how to treat dental abscess

Answer 15

• Drain abscess and disinfect
• Prescribe antibiotics

Question 16

Describe red flag signs and symptoms of spreading dental infections, with ref to appropriate referral

Answer 16

• Temp <36 or >38
• Elevated breathing rate >20 breaths per minute
• Elevated or reduced heart rate
• Facial swelling
• Trismus
• Dehydration
• Refer to oral or maxillofacial surgeon

Question 17

what is PAMP and DAMP

Answer 17

Pattern associated molecular patterns
- exogenous factors expressed by pathogen

damage associated molecular patterns
- endogenous factors released from cell damage

Question 18

when the innate immunity is activated during sepsis, what occurs

Answer 18

activation of inflammatory signaling pathways

PAMP and DAMPs (LPS, peptidoglycan and Nucleic acids/proteins) bind to the TLR and other receptors on the cell surface

release of chemokines, cytokines, IFN

this causes vasodilation, increased inflammatory response, cytokine storm

macrophages secrete TNF alpha

Question 19

what is TNF alpha and how is it related to sepsis

Answer 19

TNF alpha is released by macrophages in innate immunity

TNF alpha coordinates local containment of infection but when it enters systemic circulation, it drives sepsis

Question 20

how does TNF alpha coordinate local containment of infection

Answer 20

• Expression of adhesion molecules, Recruits immune cells
• Triggers blood clotting, Clot stops pathogens from spreading via blood

Question 21

what happens when TNF alpha enters systemic circulation

Answer 21

drives sepsis

• Systemic vasodilation
• Increased vascular permeability
• Loss of blood pressure
• Systemic blood clotting of microvasculature

Question 22

when is the complement system activated

Answer 22

immediately upon the recognition of PAMPs and DAMPs

Question 23

what does the complement system do

Answer 23

generates C3 and C5

C5 drives immunopathogenesis

o Potent chemoattractant (opsonization)
Membrane attack complex
o Further amplifies inflammation
o Vasodilation
o Tissue damage
o Organ failure

Question 24

how does the vascular endothelium change in response to inflammation

Answer 24

Endothelial barrier dysfunction

endothelium loses its anticoagulative function

theres slow blood flow
loss of tight junctions
leaky vessels
body wide blood vlotting

Question 25

why is there body wide blood clotting in sepsis

Answer 25

the body enters a hypercoagulative state due to the coagulation system being activated more

Question 26

what happens in hypercoagulation

Answer 26

o Micro vascular thrombi
o Fibrin deposition
o Neutrophils extracellular trap formation
o Endothelial injury

Question 27

what is the adaptive immunity

Answer 27

patients with sepsis demonstrate excessive inflammation AND immune suppression

Question 28

what mediates excessive inflammation

Answer 28

• pro inflammatory mediators
• coagulation activation
• endothelium dysfunction
• complement system activation
• leukocyte recruitment

all these drives
1 vasodilation and leaky vessles
2 hypotension
3 body wide blood clotting
4 organ failure

Question 29

immune suppression associated with what type of cells

Answer 29

INCREASED APOPTOSIS of t cells and b cells

dysfunctional DC cells

delayed apoptosis of immature dysfunctional neutrophils