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RM - GI Conditions Profile > Sepsis > Flashcards

Sepsis Flashcards

1
Q

Define colonisation

A

When a microbe is present, but there is no associated immune reaction

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2
Q

Define infection

A

Inflammation due to the presence of a microbe

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3
Q

Define bacteraemia

A

The presence of a bacteria in the blood

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4
Q

Define sepsis

A

The maladaptive systemic inflammatory response to an infection

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5
Q

What does this describe:

‘Life-threatening organ dysfunction due to dysregulated host response to infection’

A

Sepsis

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6
Q

Define septic shock

A

A sub-set of sepsis that involves cellular/metabolic dyfunction

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7
Q

What 3 things about an infection/inflammatory response make it more difficult to identify the location or causative organism?

A

Unusual host response
Site of infection (causing generalised symptoms)
Unusual microbe response

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8
Q

What 5 things contribute to an unusual host response to an infection?

A 
Age
Co-morbidities
Immunosuppression
Genetics
Drugs
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9
Q

Infection in what 2 locations are very difficult to diagnose?

A

Heart

Bone

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10
Q

What 3 immune components respond to a bacterial infection?

A

Phagocytes
T-lymphocytes
Complement system

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11
Q

What are the 2 immune components that react to a viral infection?

A

T-lymphocytes

Anti-bodies and B-lymphocytes

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12
Q

What are the 3 components of the immune system that respond to a fungal infection?

A

Phagocytes
T-lymphocytes
Eosinophils

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13
Q

Which 2 immune system components react to a protazoa infection?

A

T-lymphocytes

Eosinophils

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14
Q

What 2 immune system components react to a worms infection?

A

Eosinophils

Mast cells

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15
Q

If someone has pain, that is normally (the site/not the site) of the infection

A

The site

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16
Q

What are the 4 most common causes of peritonitis?

A

Perforated DU, appendix, diverticulum or tumour

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17
Q

What 3 symptoms are indicative of a local infection (rather than a systemic one)?

A

Pain/tenderness
Guarding
Sometimes blood PR

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18
Q

What are the 6 symptoms of a systemic infection?

A 
Fever
Chills or rigors
Nausea and vomiting
Constipation or diarrhoea
Malaise
Anorexia
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19
Q

What and where is the SOFA score used for?

A

In ICU to assess the severity of sepsis

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20
Q

What does SOFA stand for?

A

Sequential sepsis related organ function assessment

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21
Q

What sepsis severity assessment is primarily used on wards?

A

qSOFA

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22
Q

What does the qSOFA score assess in terms of sepsis?

A

The likely outcome (rather than diagnostic)

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23
Q

What are the 3 measured components of the qSOFA score?

A

RR > 22/min
sBP <100mmHg
Altered GCS

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24
Q

What one biochemical marker is also very important in determining the outcome of sepsis?

A

Lactate (measures organ damage)

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25
If a patient has a qSOFA score of 0, what is their mortality?
<1 %
26
If a patient has a qSOFA score of 1, what is their mortality?
2-3%
27
If a patient has a qSOFA score of >2, what is their mortality?
>10%
28
Other than qSOFA, what is the other criteria that can be used to identify sepsis?
SIRS criteria
29
What does SIRS stand for?
Systemic Inflammatory Response Syndrome
30
What are the 4 components of the SIRS criteria?
Temp <36 or >38 HR >90/min RR >20 min (or PaCO2 <33mmHg/4.3kPa) WCC <4000/uL or >12,000/ uL
31
What is the downside of the SIRS criteria?
It is not only sepsis that can cause the SIRS responce
32
What are the 3 other conditions that can cause a raised SIRS criteria?
Burns Trauma Acute pancreatitis
33
What is needed for sepsis to be confirmed via SIRS?
2 SIRS + infection history
34
If a patient scores 2 on the SIRS criteria, but has no history of infection, do they have sepsis?
No
35
What are the 2 components of septic shock?
Hypotension that is resistant to fluid resuscitation | Evidence of one acute organ dysfunction
36
What are the 4 lab tests you should do to confirm sepsis?
Microbiology WCC CRP Platelets/clotting
37
Other than lab tests, what 3 other investigations should be done for a patient with suspected sepsis?
Serology Antigen detection PCR
38
What are the 3 community acquired sources of bacteraemia?
E.coli S.pneumoniae S. aureus
39
What kind of stap. aureus is normally community acquired?
MSSA
40
What are the 2 main sources of E. coli within the body?
Urine | Abdomen
41
What is the primary source of s. pneumonia in the body?
Respiratory system
42
What is the primary community acquired source of staph. aureus?
Skin
43
What are the 6 key sources of hospital acquired bacteremia?
``` E. coli S. aureus CNS Enterococci Klebsiella Pseudomonas app. ```
44
What type of staph. aureus is normally hospital acquired?
MRSA
45
What are the 2 places you would most likely get a hospital acquired bacteraemia from stap. aureus?
Line | Wound
46
What are the 3 places you could get a hospital acquired bacteraemia from Enterococci?
Urine Wound Line
47
What are the 2 places you could get a hospital acquired bacteraemia from Klebsiella?
Urine | Wound
48
What kind of organism are E.coli, Klebsiella, Proteus, Enterobacter and serratia?
Coliforms
49
Where do coliforms primarily inhabit?
Large bowel
50
What does it mean if an organism is a strict/true aerobe?
They require oxygen for growth
51
Give an example of a strict aerobe
Pseudomonas
52
Define aerobic organisms
Organisms that grow better with oxygen, but can grow without it
53
What type of organism are the majority of human pathogens (e.g. streptococci, enterococci and coliforms)
Aerobic organisms
54
Define strict anaerobes
Organisms that will not grow in the presence of oxygen
55
Where in the body are there large numbers of strict anaerobes?
In the large bowel
56
What type of organism are clostridium and bacteroides?
Strict anaerobes
57
What are the 5 organisms present in the mouth?
Strep. viridans Neisseria sp. Anaerobes Few candida and staphylococci
58
Normally, the stomach and duodenum are ____ due to their low pH
Sterile
59
What are the 2 types of organisms that may survive in the stomach/duodenum?
Candida | Staphylcocci
60
What are the 2 types of organisms found in the jejunum?
Small numbers of coliforms and anaerobes
61
What are the organisms in the colon also known as?
Faecal flora
62
What are the 3 main types of organisms living in the colon?
Coliforms Anaerobes Enterococcus faecalis
63
The bile ducts are usually ____
sterile
64
If a patient has a serious infection, how should antibiotics be administered initially?
Parentally | can then move to oral
65
Normally, how long are antibiotics administered for in severe infections?
10-14 days
66
If a severe infection is complicated, how long are antibiotics normally administered for?
4-6 weeks
67
What do you have to be careful/aware of when prescribing antibiotics, particularly in the elderly?
C. diff
68
What are the 3 antibiotics empirically prescribed for intra-abdominal infections?
Amoxicillin Gentamicin Metronidazole
69
What is given to kill of the streptococci and enterococci of an intra-abdominal infection?
Amoxicillin
70
What is given to kill off the aerobic coliforms present in an intra-abdominal infection?
Gentamicin
71
What is administered to kill off the anaerobes in an intra-abdominal infection?
Metronidazole
72
Why can large abscesses not be treated using antibiotics?
They have no blood supply, meaning the antibiotics would have no effect
73
What is the treatment for a large abscess?
Surgical drainage
74
What combination of antibiotics should be given to a patient with intra-abdominal sepsis who are penicillin allergic?
Gentamicin Co-trimoxazole Metronidazole
75
What 2 antibiotics are given in prophylaxis for GI/Hepatobiliary surgery?
Gentamicin | Metronidazole
76
What are the 2 key adverse effects of gentamicin?
Nephrotoxicity | Ototoxicity (deaf)
77
What is the duration of gentamicin treatment if the organism has been ID'ed and approval has been obtained?
72 hours
78
If there is a concern for renal function, how long should gentamicin be administered for?
24 hrs
79
What must be monitored daily in patients on gentamicin?
Renal function
80
What is used to keep track of the gentamicin concentration in a patient?
Normogram
81
What should the blood/serum conc of gentamicin be before administering the next dose?
Low
82
State the Sepsis Six bundle
``` B - Blood cultures U - Urine output F - Fluids IV A - Antibiotics L - Lactate and FBC O - High flow Oxygen ```
83
How much IV fluids should be given ASAP in a sepsis patient?
500ml
84
What should be taken in parallel with the blood cultures?
Any other relevant cultures (wound, abscess etc)
85
What is a high lactate indicative of?
A greater need for intensive care
86
What does urine output assess?
Kidney perfusion
87
How long do you have to complete the sepsis 6 bundle?
1 hour
88
How long should antibiotics be prescribed in patients with intra-abdominal infections?
4-10 days

RM - GI Conditions Profile (4 decks)

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