Sepsis

Question 1

What is sepsis?

Answer 1

life threatening organ dysfunction due to dysregulated host response to infection

Question 2

what is septic shock?

Answer 2

persisting hypotension requiring treatment to maintain BP despite fluid resus.

Question 3

What is bacteraemia?

Answer 3

presence of bacteria in blood?

Question 4

How is diagnosis made for sepsis?

Answer 4

EWS, clinical features suggesting source e.g. UTI, red flag e.g tachycardia, low BP

Question 5

What are urgent investigations to undertake to measure extent of sepsis?

Answer 5

• urea and electrolytes to measure kidney function
• LFTs to measure liver function
• CRP
• blood sugar
• blood gases
• FBC

Question 6

What is the sepsis 6?

Answer 6

in first hour:

• high flow oxygen
• empirical antibiotics
• IV fluid
• blood cultures
• serum lactate
• urine output

note in case of meningitis can take CSF if safe to do so

once cultures come back, commence more specific antibiotics

Question 7

Neisseria meningitidis can cause sepsis. Give an overview of the organism

Answer 7

-most people are harmlessly colonised as it is part of nasopharynx flora but some can deteriorate rapidly and can be fatal

• spread by nasopharyngeal secretions and aerosols
• numerous serogroups (A,B, C, W-135)
• fatality rate around 10%
• gram negative, polysaccharide capsular antigen (produces endotoxins), evade immune response by preventing phagocytosis
• causes non blanching purpuric rash due to small blood vessel bleeding.

-causes systemic vasodilation which can cause shock, endotoxins bind macrophages which release cytokines (TNF, IL1). Cytokines initiate production of thrombin
and thus promote coagulation Cytokines also inhibit fibrinolysis.  Coagulation cascade leads to
microvascular thrombosis and hence organ ischaemia, dysfunction and failure