Sepsis

Question 1

Sepsis =

Answer 1

SIRS + infection

Question 2

SIRS

Answer 2

Signs of serious systemic inflammation (two or more of the following for diagnosis):

1) T >38.5
2) HR >90
3) RR >20
4) WBC >12,000 or <4,000

Question 3

Septic shock =

Answer 3

Sepsis + severe hypotension (SBP <60)

Question 4

Non-infectious causes of SIRS:

Answer 4

Autoimmune disease
Drug reactions
Anaphylaxis
Trauma

Question 5

Sites of primary infection in severe sepsis:

Answer 5

Lung (Common ...)
Primary bloodstream
Intra-abdominal
Urinary tract
Skin and soft tissue (... Rare)

Question 6

Process of sepsis development:

Answer 6

1) Infection (may not always be obvious)
2) A small number of immune cells produce cytokines
3) Widespread activation of other immune cells

Question 7

Immune effects in sepsis:

Answer 7

Blood vessels dilate (leading to hypotension)
Blood vessel leak (leading to hypotension)
Cytokine overproduction
Sympathetic overactivation (tissue ischemia)

Question 8

Sepsis treatment:

Answer 8

TREAT THE UNDERLYING INFECTION. People who get the right antibiotic are 50% less likely to die.
Aggressive intravenous fluid resuscitation (normal saline).
Administration of vasopressors (norepinephrine/vasopressin).
Intensive monitoring
Tight glucose control (prevent hyperglycemia)
Mechanical support for respiratory and renal failure