Sepsis

Question 1

what is SIRS

Answer 1

2 or more of the following
- temp >38, 90
- RR >20,
WBC > 12,000 or <4000

Question 2

What causes SIRS

Answer 2

Most often infection
then
Pancreatitis, burns, trauma, ischemia other

Question 3

Sepsis

Answer 3

SIRS with proven infection

Question 4

Severe sepsis

Answer 4

Sepsis with evidence of

• Organ dysfunction
• Hypotension
• Hypoperfusion

Question 5

Septic shock

Answer 5

Severe sepsis with

- Hypotension unresponsive to fluid

Question 6

organ dysfunction in severe sepsis is assessed with SODA

Answer 6

Resp failure
CV failure
Liver or renal failure
Thrombotic dysfunction 
or Low GCS

Question 7

The normal innate response includes

Answer 7

PAMPs and DAMPs - LPS in gram negatives

- activate cytokines and immune system

Question 8

Anti-inflammatory response includes

Answer 8

IL-4, IL-10
IL1R antagonist, soluble TNF-receptor
Release Cortisol
Pro-coagulant response to limit pathogen spread

Question 9

Sepsis occurs when

Answer 9

The normal immune response becomes self-perpetuating, unregulated and systemic

Question 10

How is vascular permeability adaptive and maladaptive?

Answer 10

1- adaptive: Increase delivery of PMNs

2- Maladaptive: Hypotension, ARDS

Question 11

How is Increase platelet adherence adaptive and maladaptive?

Answer 11

1- adaptive: Wall off site of infection

2- Maladaptive: DIC, thrombosis

Question 12

How is VASOdilation adaptive and maladaptive?

Answer 12

1- adaptive: increase local blood flow

2- Maladaptive: Tissue elsewhere becomes hypoxic, and leads to lactic acidosis

Question 13

How are anti-inflammatory mediators adaptive and maladaptive?

Answer 13

1- adaptive: limit inflammation

2 - maladaptive: Net state of immunosuppression

Question 14

Remember that the clinical manifestations of the infectious disease is due to 2 effects

Answer 14

The pathogen

AND the immune system

Question 15

Treatment of septic shock involves

Answer 15

Abx - AND supportive care

Question 16

Mortality rate with sepsis

Answer 16

30.5% , 45% require ICU

Question 17

Severe sepsis accounts for ? admissions

Answer 17

40% of admissions and 45% of deaths

Question 18

Treating the infection due to sepsis

Answer 18

1- broad spectrum Abx

2- source control -

Question 19

What is the most common site of infection in severe sepsis

Answer 19

Lung - then abdomen

Question 20

Always give a broad spectrum Abx first

Answer 20

mortality goes up every 30 mins - speed is the essence

Question 21

Purpose of early goal-directed therapy

Answer 21

ensure adequate organ perfusion

Question 22

“early” in early goal-directed therapy

Answer 22

Resuscitation in the ER within 6 hours of presentation

Question 23

“goal-directed” in early goal-directed therapy

Answer 23

specific targets that are evidence of near-normal function

Question 24

What 2 drugs can you give in sepsis management

Answer 24

Epi and dobutamine

Question 25

What adjunctive therapies can you give in septic shock

Answer 25

If >1 hr - despite fluids and pressors

• Give corticosteroids
• Target normoglycemia
• early within 48 hr nutrition

Question 26

Normal innate immune system response in an infection

Answer 26

cytokines allow increased permeability, increased local blood flow, increased PMNs, complement and antibacterial proteins -