Sepsis

Question 1

define sepsis

Answer 1

life-threatening organ dysfunction caused by dysregulated host response to infection

Question 2

define colonisation

Answer 2

presence of microbe in human body without inflam response

Question 3

define infection

Answer 3

inflam due to microbe

Question 4

define bacteraemia

Answer 4

presence of viable bacteria in blood

Question 5

what is the 2016 consensus definition of septic shock

Answer 5

persisting MAP<65 & lactate>2 despite euvolemia (adequate fluid resuscitation)

Question 6

what infections are enteroccous streptococci associated with

Answer 6

gut commensal, UTI

Question 7

define septicaemia

Answer 7

“booby trap for exams”

Question 8

in which patients might you suspect a biofilm

Answer 8

prosthetic, CF, bronchiectasis

Question 9

what sequence of events cause metabolic acidosis in sepsis

Answer 9

hypotension > hypoperfusion > hypoxia > anaerobic metabolism > lactic acid accumulation

Question 10

what causes hypotension in sepsis

Answer 10

toxins stimulate TNFa to produce vasodilator NO and cause endothelial damage leading to leakiness

Question 11

how is sepsis screened for

Answer 11

qSOFA, NEWS, SIRS, NICE

Question 12

what is the general presentation of sepsis

Answer 12

pyrexic, pale/cold/clammy, muscle ache, confusion

Question 13

what is required for a diagnosis of sepsis

Answer 13

NEWS2 >5 and suspected infection

Question 14

what is the problem with SIRS

Answer 14

screens non-specific inflam not just infection

Question 15

what are criteria for SIRS

Answer 15

2 of
temp >36 / <38
HR >90
RR >20
WBC <4 / > 12 / 10% immature neutrophils
confused

Question 16

what is the sepsis 6

Answer 16

oxygen
fluids
blood culture and other cultures
IV empirical antibiotics
lactate, FBC & biochemistry
monitor urine output

Question 17

what are the target oxygen saturations

Answer 17

target 94-98% unless COPD/severe sepsis

Question 18

what fluid should be give

Answer 18

500ml bolus 0.9% sodium chloride

Question 19

what is an alternative fluid regimen

Answer 19

Hartmann’s solution

Question 20

what type of fluids are sodium chloride and Hartmann’s solution

Answer 20

crystalloids

Question 21

what fluid should never be given for sepsis

Answer 21

5% dextrose

Question 22

what should be done after giving 500ml of 0.9% NaCl

Answer 22

reassess HR, BP, RR, UO and repeat bolus until normal

Question 23

what drugs should be considered for hypotension despite euvolaemia (aka septic shock)

Answer 23

inotrope / vasoconstrictor e.g. noradrenaline via a central venous catheter

Question 24

what MAP are you aiming for in hypotension management

Answer 24

> 65

Question 25

what MAP are you aiming for in hypotension management

Answer 25

>65

Question 26

in what scenario should you give antibiotics before culture

Answer 26

purpura fulminans

Question 27

what should be done after the microbiology result for antibiotic stewardship

Answer 27

stop, PO switch, change to narrow-spectrum, review after 24hr

Question 28

what other blood tests should be done that aren't included in sepsis 6

Answer 28

Hb, CRP, creatinine, clotting screen, ABG, bilirubin, LFTs

Question 29

what is a normal serum lactate and does an elevated lactate suggest

Answer 29

normal <1.8, suggests hypoperfusion/hypoxia

Question 30

what options are there or measuring urine output

Answer 30

record volume or catheterise for hourly volumes

Question 31

when should you catheterise the patient

Answer 31

if urine output <60ml after 2 hours

Question 32

what is qSOFA used for

Answer 32

abbreviated version of SOFA, prognostic indicator

Question 33

what are the criteria for qSOFA

Answer 33

RR>22, sBP<100, altered GCS

Question 34

what time of oedema is a complication of sepsis

Answer 34

non-cardiogenic pulmonary oedema

Question 35

what is the incubation period

Answer 35

time between encountering bug and symptom onset

Question 36

what is the prodromal period

Answer 36

early signs of symptoms before actual signs

Question 37

what is DIC

Answer 37

disseminated intravascular coagulation, comp of sepsis

Question 38

what is the red flag for acute kidney injury in sepsis

Answer 38

oligurea

Question 39

what is the management of pyomyositis

Answer 39

urgent surgical debridement + 6wk IV ABx

Question 40

what is a complication of pyomyositis

Answer 40

septic emboli caused pneumonia and endocarditis