Sepsis

Question 1

Define sepsis

Answer 1

life-threatening organ dysfunction due to a dysregulated host response to infection

Question 2

Define Septic shock

Answer 2

persisting hypotension requiring vasopressor therapy to maintain a mean arterial pressure of 65 mmHg or more, and serum lactate level greater than 2 mmol/L despite adequate volume resuscitation

Question 3

List the cardiovascular effects of sepsis

Answer 3

Vasodilatation (endothelial NO and prostacyclin)
Loss of intravascular volume
Impaired vasopressin production
Myocardial dysfunction

Question 4

List the respiratory effects of sepsis

Answer 4

Pulmonary oedema

Question 5

List the neurological effect of sepsis

Answer 5

Septic encephalopathy (altered cognitive function during an episode of sepsis)
Critical illness polyneuropathy

Question 6

Define systemic inflammatory response syndrome

Answer 6

Two or more of the following criteria:
Heart rate >90 BPM
Body temperature <36 or >38°C
Tachypnoea >20 breaths per minute or PaCO2 <4.3 kPa (32 mm Hg)
White blood cell count <4x10^9 or >12x10^9 cells/L, or the presence of >10% immature neutrophils

Question 7

What are the most common sites of infection leading to sepsis

Answer 7

respiratory, gastrointestinal, renal and genitourinary tracts
blood, skin or soft tissue sources

Question 8

What are the most common causative organisms in sepsis in adults

Answer 8

Staphylococcus aureus
Pseudomonas species
Escherichia coli

Question 9

What are the most common causative organisms in sepsis in children

Answer 9

Neisseria meningitides
Haemophilus influenzae

Question 10

List the risk factors for sepsis

Answer 10

Infants (age<1yr) and older people (age>75yrs)
Frail
Immunocompromised
Immunosuppressed
Trauma, surgery, invasive procedures in the past 6 weeks
Breach of skin integrity
IV drug / alcohol misuse
Indwelling lines / catheters
Women
* Pregnant, postpartum, termination of pregnancy, miscarriage in the past 6 weeks
* C-section, forceps delivery, removal of retained products of conception
* Prolonged rupture of membranes
* Close contact with group A strep eg. scarlet fever
* Ongoing vaginal bleeding / offensive vaginal discharge

Question 11

List the complications of sepsis

Answer 11

Death (25–30%)
Organ dysfunction and failure
* AKI
* Cholestasis
* Heart failure
* ARDS / acute lung injury
Recurrent/secondary infection
Coagulopathy (thromboembolism/DIC)
Neurological sequelae
* Focal neuro deficits, hearing loss (up to 30% with meningitis)
* Polyneuropathy (70%)
Cognitive and functional disability

Question 12

List the high risk criteria for sepsis in age 12+ and pregnant

Answer 12

Objective evidence of new altered mental state
Respiratory
* Raised RR >25 breaths per minute
* New need for O2 (≥40% FiO2) to maintain saturation >92% (or >88% in COPD)
BP: SBP <90mmHg or >40mmHg below normal
Circulation and hydration
* Raised HR >130BPM
* Not passed urine in previous 18 hours
* For catheterized patients, passed less than 0.5 ml/kg of urine per hour
Skin
* Mottled or ashen appearance
* Cyanosis of skin, lips, or tongue
* Non-blanching petechial or purpuric rash

Question 13

Patients with suspected sepsis can be identified at the bedside using quick SOFA (qSOFA). Define qSOFA

Answer 13

Alteration in mental status
Systolic blood pressure ≤100 mmHg
Respiratory rate ≥22/min

Question 14

List the items considered in SOFA score

Answer 14

Respiration (PaO2/FiO2)
Coagulation - platelets
Liver - bilirubin
Cardiovascular
* MAP
* Inotropes
CNS - GCS
Renal
* Creatinine
* Urine output