Sepsis

Question 1

Define sepsis:

Answer 1

a systemic inflammatory response in infection that results in illness and can progress to organ dysfunction/failure

• common, high mortality
• alt: SIRS in response to infection

Question 2

Systemic inflammatory response syndrome (SIRS)

Answer 2

must have two of the following:

1) temp 38
2) pulse > 90
3) RR > 20 or PaCO2 >32
4) WBC 12, 000 or bands > 10%

Question 3

severe sepsis

Answer 3

sepsis plut evidence of hypoperfusion, hypoTN or failure of at least one organ/organ system

Question 4

septic shock

Answer 4

severe sepsis +

1) ongoing hypoTN despite volume resuscitation
2) need for vasopressors to maintain BP

Question 5

refractory septic shock

Answer 5

HypoTN despite vasopressor use

Question 6

how does the host immune response contribute to the development and progression of sepsis?

Answer 6

sepsis is widespread, uncontrolled inflammation and anti-inflammation, concentrations of various cytokines vary and are inappropriately elevated

Question 7

pro-inflammatory cytokines…

Answer 7

TNF-alpha, IL - 6, IL - 1beta, C5a

-increase blood flow to the area, attract lymphocytes, vasodilation

Question 8

anti-inflammatory cytokines

Answer 8

IL-10, cortisol
-serves to mobilize marginated leukocytes and prevents injury to distant organs, used to confine the bad/toxic components to one area

Question 9

examples of sepsis-related organ failure

Answer 9

acute respiratory distress syndrome (ARDS), mottled skin, cap refill > 3, lactate elevated, decreased urine output, AMS, abnl EEG, platelet count less or DIC

Question 10

Four components of the pathogenesis of organ dysfunction

Answer 10

1) hypoperfusion
2) O2 utilization/ metabolism
3) coagulopathy
4) programmed cell death

Question 11

hypoperfusion results when____? (3)

Answer 11

1) there is excessive vasodilation (decreases BP), impairs region blood flow (increases the chance of redistributive shock)
2) endothelial dysfunction (edema)
3) cardiac dysfunction

Question 12

(T/F) patients who survive early sepsis are less likely to develop severe sepsis later

Answer 12

False, they are more likely due to the increased release of anti-inflammatory cytokines, T cell exhaustion, lymphocyte apoptosis, impaired expression of APCs

Question 13

Mortality rises approximately ____ % for each failing organ system

Answer 13

15-20

Question 14

Two main interventions in sepsis management:

Answer 14

1) treat the infection appropriately IMMEDIATELY (source control and Abx)
2) institute resuscitation to optimize tissue perfusion IMMEDIATELY