Sepsis

Question 1

Q: What is sepsis?

Answer 1

A: Sepsis is an exaggerated immune response to infection associated with organ dysfunction, shock, and death.

Question 2

Q: What types of infections can lead to sepsis?

Answer 2

A: Bacterial, viral, or fungal infections can lead to sepsis.

Question 3

Q: What are the main goals of sepsis management?

Answer 3

A: To identify and treat the infection while maintaining hemodynamic stability to prevent or minimize organ damage.

Question 4

Q: What initial assessment tool can be used to identify sepsis?

Answer 4

A: The systemic inflammatory response syndrome (SIRS) criteria.

Question 5

Q: What are the SIRS criteria for diagnosing sepsis?

Answer 5

A: At least two of the following: WBC count < 4,000 or > 12,000, body temperature < 36°C or > 38°C, heart rate > 90 beats per minute, and respiratory rate > 20 breaths per minute.

Question 6

Q: What should raise suspicion for sepsis in a patient?

Answer 6

A: The presence of known or suspected infection together with SIRS criteria.

Question 7

Q: What metric helps identify patients at greatest risk of poor outcomes in sepsis?

Answer 7

A: The Sequential Organ Failure Assessment (SOFA) score.

Question 8

Q: What does the 1-hour sepsis bundle include?

Answer 8

A: Measure blood lactate level, collect blood cultures, begin broad spectrum IV antibiotics, and monitor SBP and lactate levels.

Question 9

Q: What indicates sepsis without shock?

Answer 9

A: SBP above 90 mmHg and normal lactate levels.

Question 10

Q: What indicates septic shock?

Answer 10

A: SBP below 90 mmHg, a fall of 40 mmHg below baseline, or elevated lactate levels.

Question 11

Q: What is the initial management for sepsis without shock?

Answer 11

A: Continue maintenance IV fluids, aiming for urine output of 0.5 mL/kg/h or more and CRT of less than 3 seconds.

Question 12

Q: What is the initial management for septic shock?

Answer 12

A: Begin IV crystalloids dosed at 30 mL/kg, monitor MAP with a target of 65 mmHg or above, and consider adding IV vasopressors if MAP falls below 65 mmHg.

Question 13

Q: What should be done after completing the 1-hour sepsis bundle?

Answer 13

A: Perform a thorough history and physical examination, order labs and imaging to identify the source of infection and any organ dysfunction.

Question 14

Q: What are key lab tests to order in suspected sepsis?

Answer 14

A: CBC with differential, electrolytes, liver function test, BUN and creatinine, ABG, coagulation studies, D-dimer, and procalcitonin levels.

Question 15

Q: How can procalcitonin levels guide antibiotic management?

Answer 15

A: A falling procalcitonin level indicates a resolving infection.

Question 16

Q: What should be monitored closely in a patient with sepsis or septic shock?

Answer 16

A: Hemodynamic parameters and indicators of perfusion to avoid decompensation.

Question 17

Q: What organ dysfunctions are associated with sepsis?

Answer 17

A: Acute liver failure, acute kidney injury, disseminated intravascular coagulation (DIC), and pulmonary edema.

Question 18

Q: When should you consider consulting with a specialist in sepsis management?

Answer 18

A: When lab and imaging abnormalities suggest organ dysfunction.

Question 19

Q: What is the purpose of monitoring lactate levels in sepsis management?

Answer 19

A: To guide the intensity of hemodynamic resuscitation measures.

Question 20

Q: Why might multiple specialities be involved in the management of sepsis or septic shock?

Answer 20

A: Due to the complexity and potential for multiple organ system failures.

Question 21

Q: What is the clinical definition of sepsis?

Answer 21

A: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.

Question 22

Q: What characterizes septic shock?

Answer 22

A: Septic shock is characterized by persistent hypotension requiring vasopressors to maintain a mean arterial pressure (MAP) of ≥ 65 mm Hg and having a serum lactate level > 2 mmol/L despite adequate fluid resuscitation.

Question 23

Q: What types of infections commonly lead to sepsis?`

Answer 23

A: Infections that commonly lead to sepsis include pneumonia, urinary tract infections, intra-abdominal infections, and bloodstream infections.

Question 24

Q: Which Gram-negative bacteria are frequently associated with sepsis?

Answer 24

A: Gram-negative bacteria frequently associated with sepsis include Escherichia coli, Klebsiella species, and Pseudomonas aeruginosa.

Question 25

Q: Why are elderly patients more susceptible to sepsis?

Answer 25

A: Elderly patients are more susceptible to sepsis due to their weakened immune systems, the presence of multiple comorbidities, and the likelihood of delayed recognition and treatment of infections.

Question 26

Q: What are specific risk factors for sepsis in hospitalized patients?

Answer 26

A: Specific risk factors for sepsis in hospitalized patients include the use of indwelling catheters, recent surgeries, and invasive procedures.

Question 27

Q: How does the dysregulated immune response in sepsis lead to tissue damage?

Answer 27

A: The dysregulated immune response in sepsis leads to excessive production of pro-inflammatory cytokines, causing widespread tissue damage and endothelial dysfunction, resulting in increased vascular permeability and coagulopathy.

Question 28

Q: What is the role of endothelial dysfunction in sepsis?

Answer 28

A: Endothelial dysfunction in sepsis contributes to impaired blood flow, increased vascular permeability, and the formation of microthrombi, which can lead to tissue hypoperfusion and organ failure.

Question 29

Q: What are the early signs of sepsis?

Answer 29

A: Early signs of sepsis include fever, chills, tachycardia, tachypnea, confusion or disorientation, and low blood pressure.

Question 30

Q: What symptoms might indicate progression to septic shock?

Answer 30

A: Symptoms indicating progression to septic shock include severe hypotension, decreased urine output, mottled or discolored skin, and altered mental status.

Question 31

Q: What criteria are used in the qSOFA score for sepsis?

Answer 31

A: The qSOFA score includes three criteria: respiratory rate ≥ 22 breaths per minute, altered mentation (Glasgow Coma Scale score < 15), and systolic blood pressure ≤ 100 mm Hg.

Question 32

Q: How does the SOFA score aid in assessing the severity of sepsis?

Answer 32

A: The SOFA score assesses the severity of sepsis by evaluating six organ systems: respiratory, cardiovascular, hepatic, coagulation, renal, and neurological functions. Higher scores indicate greater organ dysfunction and worse prognosis.

Question 33

Q: What is the first step in managing a patient with suspected sepsis?

Answer 33

A: The first step in managing a patient with suspected sepsis is to administer broad-spectrum antibiotics within one hour of recognition.

Question 34

Q: What fluid resuscitation strategy is recommended for septic shock?

Answer 34

A: The recommended fluid resuscitation strategy for septic shock is the administration of 30 mL/kg of intravenous crystalloids within the first three hours.

Question 35

Q: What is acute respiratory distress syndrome (ARDS) and how is it related to sepsis?

Answer 35

A: ARDS is a severe lung condition characterized by rapid onset of widespread inflammation in the lungs. It is a common complication of sepsis due to the inflammatory response and damage to the alveolar-capillary barrier.

Question 36

Q: How does disseminated intravascular coagulation (DIC) develop in sepsis?

Answer 36

A: DIC develops in sepsis due to the widespread activation of the coagulation cascade, leading to the formation of microthrombi, consumption of clotting factors, and subsequent bleeding complications.

Question 37

Q: What is the impact of early goal-directed therapy on sepsis outcomes?

Answer 37

A: Early goal-directed therapy, which involves early aggressive management of sepsis including fluid resuscitation, vasopressors, and timely antibiotics, has been shown to improve outcomes and reduce mortality in sepsis patients.

Question 38

Q: How does organ dysfunction affect the prognosis of sepsis?

Answer 38

A: The extent and number of organ systems involved in dysfunction directly affect the prognosis of sepsis. Multiple organ dysfunction syndrome (MODS) is associated with a significantly higher risk of mortality.

Question 39

Q: What hemodynamic parameters should be closely monitored in sepsis patients?

Answer 39

A: Hemodynamic parameters that should be closely monitored include blood pressure, heart rate, urine output, central venous pressure (CVP), and lactate levels.

Question 40

Q: Why is frequent monitoring of lactate levels important in sepsis?

Answer 40

A: Frequent monitoring of lactate levels is important because elevated lactate is an indicator of tissue hypoperfusion and can guide the intensity of resuscitation efforts.

Question 41

Q: How should antibiotic therapy be adjusted once the causative organism is identified?

Answer 41

A: Once the causative organism is identified, antibiotic therapy should be de-escalated to the narrowest spectrum agents effective against the identified pathogen to reduce the risk of antibiotic resistance and adverse effects.

Question 42

Q: What is the role of procalcitonin levels in antibiotic management?

Answer 42

A: Procalcitonin levels can help guide the duration of antibiotic therapy, with decreasing levels indicating resolution of infection and helping to determine when antibiotics can be safely discontinued.