Sepsis

Question 0

What may be coexistent in non-diabetics with SIRS?

Answer 0

Raised BM

Question 1

5 criteria for SIRS? How many do you need?

Answer 1

Temp > 38.3 or < 36
HR > 90
RR > 20 or PaCO2 < 32mmHg
WCC >12000 or <4000
Altered mental state

Question 2

What are the common signs that someone is developing sepsis?

Answer 2

Bounding pulse
Warm peripheries
Any of the SIRS signs

Question 3

Temp criteria for SIRS?

Answer 3

> 38.3 or < 36

Question 4

HR criteria for SIRS?

Answer 4

> 90

Question 5

Respiratory criteria for SIRS?

Answer 5

RR > 20 or PaCO2 < 32mmHg

Question 6

White cell criteria for SIRS?

Answer 6

WCC > 12000 cells/mm3 or < 4000

Question 7

When does sepsis become severe sepsis?

Answer 7

When there is detectable end organ damage

Question 8

What are the signs that someone is severely septic?

Answer 8

Hypotension
Decreased UO ( 2mmol/L
Clotting dysfunction DIC, mottled skin
CRT > 3
Reduced consciousness or altered mental state

Question 9

What are the 2 criteria for septic shock?

Answer 9

Sepsis + either:

• persistent hypotension despite adequate fluid resus
• tissue hyperperfusion as demonstrated by lactate > 4mg/dL

Question 10

What is the difference between warm and cold shock?

Answer 10

Warm = early. Peripheral dilation and increased cardiac output
Cold = late. Relative hypovolaemia and reduced cardiac output leading to peripheral underperfusion

Question 11

What is septic shock an example of?

Answer 11

Distributive shock

Question 12

Define adequate fluid resus?

Answer 12

30ml/kg colloid

40-60ml/kg crystalloid

Question 13

4 aims of primary resus for sepsis?

Answer 13

SaO2 > 95%
Systolic BP > 90, MAP > 75
Urine output > 0.5ml/kg/hr
Treat source of infection

Question 14

What is the sepsis six?

Answer 14

High flow O2 via non re-breathe mask
Blood cultures
IV Abs
IVT
Measure lactate levels
Monitor hourly UO (catheter)

Question 15

How should O2 be administered in sepsis care?

Answer 15

High flow, via non-rebreathe mask

Question 16

When should the sepsis six package have been carried out?

Answer 16

Within 1 hour

Question 17

What things can be measured to identify end organ damage as a result of severe sepsis?

Answer 17

Creatinine
Bilirubin
Platelet count
Urine output
Lactate
BP

Question 18

What is an endocrine complication of septic shock?

Answer 18

Bilateral adrenal haemorrhage

Question 19

What is Waterhouse-Friderichsen syndrome WFS also known as?

Answer 19

Haemorrhagic adrenalitis or fulminant meningococcaemia

Question 20

What is the most common cause of WFS?

Answer 20

Meningococcal sepsis

Question 21

What infectious agent has been implicated in WFS in kids?

Answer 21

Staph aureus