Sepsis

Question 0

What are the criteria for SIRS?

Answer 0

Temperature 38*C
Heart rate of > 90/min
Resp rate of >20/min
WBC 12 x 10^9

Question 1

What is SIRS?

Answer 1

Systematic inflammatory response syndrome
Response to a non-specific insult
Eg ischaemia, trauma, infection

Question 2

What is bacteriaemia?

Answer 2

Presence of live bacteria in the bloodstream

Question 3

What is septicaemia?

Answer 3

Presence of a pathogen in the bloodstream leading to sepsis

Question 4

What is sepsis?

Answer 4

SIRS triggered by an infection

Question 5

What is severe sepsis?

Answer 5

Sepsis with organ dysfunction or organ hypoperfusion

Question 6

What is septic shock?

Answer 6

Severe sepsis and persistently low BP despite administration of IV fluids

Question 7

How do microorganisms trigger the inflammatory cascade?

Answer 7

Endotoxins from bacteria bind to macrophages
Macrophages release cytokines to stimulate inflammatory response
Recruits RE system and promotes wound repair
Cytokines released into the circulation stimulate growth factors, macrophages and platelets
Thrombin production and coagulation
Cytokines inhibit fibrinolysis
Coagulation leads to microvascular thrombosis which can cause ischaemia, dysfunction and failure

Question 8

Investigations for acute sepsis?

Answer 8

Chest X-ray
Blood culture
Other routine bloods including FBC, U&Es, LFTs
ABG
Urine dipstick

Question 9

Sepsis 6?

Answer 9

Take:

• blood cultures
• check Hb and lactate
• monitor urine output

Give

• high flow oxygen
• empirical IV antibiotics
• IV fluid resuscitation

Question 10

Give features of Neisseria meningitidis

Answer 10

Gram negative

Diplococcus

Question 11

What helps Neosseria meningitidis to evade immune response?

Answer 11

Serogroups on the polysaccharide capsular antigen prevents phagocytosis

Question 12

How is meningitis spread?

Answer 12

Aerosols and nasopharyngeal secretions

Question 13

Symptoms of meningitis?

Answer 13

Headache
Irritability
Stiff neck
Photophobia
Tachycardia
Fever
Vomiting 
Seizures
Purpurin rash
Low BP

Question 14

What is used to treat meningitis and why?

Answer 14

Ceftriaxone

Penetrates into CSF and effective against the pathogen

Question 15

Life threatening complications of meningitis?

Answer 15

Irreversible hypotension
Respiratory failure
Acute kidney failure
Raised intracranial pressure
Ischaemic necrosis of digits/hands/feet