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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
Q

If a patient has a qSOFA score of 0, what is their mortality?

A

<1 %

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26
Q

If a patient has a qSOFA score of 1, what is their mortality?

A

2-3%

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27
Q

If a patient has a qSOFA score of >2, what is their mortality?

A

> 10%

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28
Q

Other than qSOFA, what is the other criteria that can be used to identify sepsis?

A

SIRS criteria

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29
Q

What does SIRS stand for?

A

Systemic Inflammatory Response Syndrome

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30
Q

What are the 4 components of the SIRS criteria?

A

Temp <36 or >38
HR >90/min
RR >20 min (or PaCO2 <33mmHg/4.3kPa)
WCC <4000/uL or >12,000/ uL

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31
Q

What is the downside of the SIRS criteria?

A

It is not only sepsis that can cause the SIRS responce

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32
Q

What are the 3 other conditions that can cause a raised SIRS criteria?

A

Burns
Trauma
Acute pancreatitis

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33
Q

What is needed for sepsis to be confirmed via SIRS?

A

2 SIRS + infection history

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34
Q

If a patient scores 2 on the SIRS criteria, but has no history of infection, do they have sepsis?

A

No

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35
Q

What are the 2 components of septic shock?

A

Hypotension that is resistant to fluid resuscitation

Evidence of one acute organ dysfunction

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36
Q

What are the 4 lab tests you should do to confirm sepsis?

A

Microbiology
WCC
CRP
Platelets/clotting

37
Q

Other than lab tests, what 3 other investigations should be done for a patient with suspected sepsis?

A

Serology
Antigen detection
PCR

38
Q

What are the 3 community acquired sources of bacteraemia?

A

E.coli
S.pneumoniae
S. aureus

39
Q

What kind of stap. aureus is normally community acquired?

A

MSSA

40
Q

What are the 2 main sources of E. coli within the body?

A

Urine

Abdomen

41
Q

What is the primary source of s. pneumonia in the body?

A

Respiratory system

42
Q

What is the primary community acquired source of staph. aureus?

A

Skin

43
Q

What are the 6 key sources of hospital acquired bacteremia?

A 
E. coli
S. aureus
CNS
Enterococci
Klebsiella
Pseudomonas app.
44
Q

What type of staph. aureus is normally hospital acquired?

A

MRSA

45
Q

What are the 2 places you would most likely get a hospital acquired bacteraemia from stap. aureus?

A

Line

Wound

46
Q

What are the 3 places you could get a hospital acquired bacteraemia from Enterococci?

A

Urine
Wound
Line

47
Q

What are the 2 places you could get a hospital acquired bacteraemia from Klebsiella?

A

Urine

Wound

48
Q

What kind of organism are E.coli, Klebsiella, Proteus, Enterobacter and serratia?

A

Coliforms

49
Q

Where do coliforms primarily inhabit?

A

Large bowel

50
Q

What does it mean if an organism is a strict/true aerobe?

A

They require oxygen for growth

51
Q

Give an example of a strict aerobe

A

Pseudomonas

52
Q

Define aerobic organisms

A

Organisms that grow better with oxygen, but can grow without it

53
Q

What type of organism are the majority of human pathogens (e.g. streptococci, enterococci and coliforms)

A

Aerobic organisms

54
Q

Define strict anaerobes

A

Organisms that will not grow in the presence of oxygen

55
Q

Where in the body are there large numbers of strict anaerobes?

A

In the large bowel

56
Q

What type of organism are clostridium and bacteroides?

A

Strict anaerobes

57
Q

What are the 5 organisms present in the mouth?

A

Strep. viridans
Neisseria sp.
Anaerobes
Few candida and staphylococci

58
Q

Normally, the stomach and duodenum are ____ due to their low pH

A

Sterile

59
Q

What are the 2 types of organisms that may survive in the stomach/duodenum?

A

Candida

Staphylcocci

60
Q

What are the 2 types of organisms found in the jejunum?

A

Small numbers of coliforms and anaerobes

61
Q

What are the organisms in the colon also known as?

A

Faecal flora

62
Q

What are the 3 main types of organisms living in the colon?

A

Coliforms
Anaerobes
Enterococcus faecalis

63
Q

The bile ducts are usually ____

A

sterile

64
Q

If a patient has a serious infection, how should antibiotics be administered initially?

A

Parentally

can then move to oral

65
Q

Normally, how long are antibiotics administered for in severe infections?

A

10-14 days

66
Q

If a severe infection is complicated, how long are antibiotics normally administered for?

A

4-6 weeks

67
Q

What do you have to be careful/aware of when prescribing antibiotics, particularly in the elderly?

A

C. diff

68
Q

What are the 3 antibiotics empirically prescribed for intra-abdominal infections?

A

Amoxicillin
Gentamicin
Metronidazole

69
Q

What is given to kill of the streptococci and enterococci of an intra-abdominal infection?

A

Amoxicillin

70
Q

What is given to kill off the aerobic coliforms present in an intra-abdominal infection?

A

Gentamicin

71
Q

What is administered to kill off the anaerobes in an intra-abdominal infection?

A

Metronidazole

72
Q

Why can large abscesses not be treated using antibiotics?

A

They have no blood supply, meaning the antibiotics would have no effect

73
Q

What is the treatment for a large abscess?

A

Surgical drainage

74
Q

What combination of antibiotics should be given to a patient with intra-abdominal sepsis who are penicillin allergic?

A

Gentamicin
Co-trimoxazole
Metronidazole

75
Q

What 2 antibiotics are given in prophylaxis for GI/Hepatobiliary surgery?

A

Gentamicin

Metronidazole

76
Q

What are the 2 key adverse effects of gentamicin?

A

Nephrotoxicity

Ototoxicity (deaf)

77
Q

What is the duration of gentamicin treatment if the organism has been ID’ed and approval has been obtained?

A

72 hours

78
Q

If there is a concern for renal function, how long should gentamicin be administered for?

A

24 hrs

79
Q

What must be monitored daily in patients on gentamicin?

A

Renal function

80
Q

What is used to keep track of the gentamicin concentration in a patient?

A

Normogram

81
Q

What should the blood/serum conc of gentamicin be before administering the next dose?

A

Low

82
Q

State the Sepsis Six bundle

A 
B - Blood cultures
U - Urine output
F - Fluids IV
A - Antibiotics
L - Lactate and FBC
O - High flow Oxygen
83
Q

How much IV fluids should be given ASAP in a sepsis patient?

A

500ml

84
Q

What should be taken in parallel with the blood cultures?

A

Any other relevant cultures (wound, abscess etc)

85
Q

What is a high lactate indicative of?

A

A greater need for intensive care

86
Q

What does urine output assess?

A

Kidney perfusion

87
Q

How long do you have to complete the sepsis 6 bundle?

A

1 hour

88
Q

How long should antibiotics be prescribed in patients with intra-abdominal infections?

A

4-10 days

RM - GI Conditions Profile (4 decks)

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