Sepsis

Question 1

What is sepsis?

Answer 1

Sepsis is a systemic inflammatory response to infection, leading to organ dysfunction and systemic inflammation.

Question 2

What is the role of cytokines in sepsis?

Answer 2

Cytokines such as interleukins and tumor necrosis factor activate the immune system, causing systemic inflammation, vasodilation, increased endothelial permeability, and the development of disseminated intravascular coagulopathy (DIC).

Question 3

How does sepsis affect blood vessels and tissue oxygenation?

Answer 3

Cytokines increase the permeability of blood vessels, causing fluid leakage into tissues, reducing intravascular volume and oxygen delivery to tissues, leading to anaerobic respiration and elevated lactate levels.

Question 4

What is septic shock?

Answer 4

Septic shock occurs when blood pressure drops despite adequate fluid resuscitation, leading to organ hypoperfusion.

Question 5

What are the diagnostic criteria for septic shock?

Answer 5

Low mean arterial pressure (below 65 mmHg) despite fluid resuscitation and raised serum lactate (above 2 mmol/L).

Question 6

What is the Sepsis-related Organ Failure Assessment (SOFA)?

Answer 6

SOFA is used to assess organ dysfunction in sepsis, including hypoxia, mechanical ventilation, thrombocytopenia, low GCS, elevated bilirubin, low blood pressure, and raised creatinine.

Question 7

What are risk factors for sepsis?

Answer 7

• Very young or old (under 1 or over 75 years) * Chronic conditions (e.g., COPD, diabetes) * Chemotherapy, immunosuppressants, or steroids * Surgery, trauma, or burns * Pregnancy and childbirth * Indwelling medical devices (e.g., catheters, central lines)

Question 8

What is the National Early Warning Score (NEWS2)?

Answer 8

NEWS2 is used to identify acutely unwell patients by monitoring temperature, heart rate, respiratory rate, oxygen saturation, blood pressure, and consciousness level.

Question 9

What are some additional signs of infection in sepsis?

Answer 9

• Mottled skin * Cyanosis * Arrhythmias (e.g., new-onset atrial fibrillation) * Non-blanching rash (meningococcal septicaemia) * Reduced urine output * Signs of local infection (e.g., cellulitis, cough, dysuria)

Question 10

What are the blood tests for suspected sepsis?

Answer 10

• Full blood count (white cell count, neutrophils) * U&Es (kidney function, acute kidney injury) * LFTs (liver function) * CRP (inflammation) * Blood glucose (hyperglycaemia/hypoglycaemia) * Clotting (DIC) * Blood cultures (bacteraemia) * Blood gas (lactate, pH, glucose)

Question 11

What are the sepsis six?

Answer 11

The Sepsis Six includes three tests and three treatments: Tests: * Serum lactate * Blood cultures * Urine output Treatments: * Oxygen (94-98% saturation, or 88-92% in COPD) * Empirical broad-spectrum antibiotics * IV fluids

Question 12

What is neutropenic sepsis?

Answer 12

Neutropenic sepsis occurs in individuals with an absolute neutrophil count below 0.5 x 10^9/L, often due to chemotherapy or immunosuppressive drugs.

Question 13

How is neutropenic sepsis managed?

Answer 13

• Immediate broad-spectrum antibiotics (e.g., piperacillin + tazobactam) * Close monitoring and escalation * Emergency admission for patients with neutropenic sepsis