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Y2 CLASP > Sepsis > Flashcards

Sepsis Flashcards

1
Q

define sepsis

A

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

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2
Q

define colonisation

A

presence of microbe in human body without inflam response

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3
Q

define infection

A

inflam due to microbe

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4
Q

define bacteraemia

A

presence of viable bacteria in blood

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5
Q

what is the 2016 consensus definition of septic shock

A

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

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6
Q

what infections are enteroccous streptococci associated with

A

gut commensal, UTI

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7
Q

define septicaemia

A

“booby trap for exams”

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8
Q

in which patients might you suspect a biofilm

A

prosthetic, CF, bronchiectasis

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9
Q

what sequence of events cause metabolic acidosis in sepsis

A

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

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10
Q

what causes hypotension in sepsis

A

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

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11
Q

how is sepsis screened for

A

qSOFA, NEWS, SIRS, NICE

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12
Q

what is the general presentation of sepsis

A

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

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13
Q

what is required for a diagnosis of sepsis

A

NEWS2 >5 and suspected infection

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14
Q

what is the problem with SIRS

A

screens non-specific inflam not just infection

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15
Q

what are criteria for SIRS

A 
2 of
temp >36 / <38
HR >90
RR >20
WBC <4 / > 12 / 10% immature neutrophils
confused
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16
Q

what is the sepsis 6

A 
oxygen
fluids
blood culture and other cultures
IV empirical antibiotics
lactate, FBC &amp; biochemistry
monitor urine output
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17
Q

what are the target oxygen saturations

A

target 94-98% unless COPD/severe sepsis

18
Q

what fluid should be give

A

500ml bolus 0.9% sodium chloride

19
Q

what is an alternative fluid regimen

A

Hartmann’s solution

20
Q

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

A

crystalloids

21
Q

what fluid should never be given for sepsis

A

5% dextrose

22
Q

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

A

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

23
Q

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

A

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

24
Q

what MAP are you aiming for in hypotension management

A

> 65

25
Q

what MAP are you aiming for in hypotension management

A

> 65

26
Q

in what scenario should you give antibiotics before culture

A

purpura fulminans

27
Q

what should be done after the microbiology result for antibiotic stewardship

A

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

28
Q

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

A

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

29
Q

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

A

normal <1.8, suggests hypoperfusion/hypoxia

30
Q

what options are there or measuring urine output

A

record volume or catheterise for hourly volumes

31
Q

when should you catheterise the patient

A

if urine output <60ml after 2 hours

32
Q

what is qSOFA used for

A

abbreviated version of SOFA, prognostic indicator

33
Q

what are the criteria for qSOFA

A

RR>22, sBP<100, altered GCS

34
Q

what time of oedema is a complication of sepsis

A

non-cardiogenic pulmonary oedema

35
Q

what is the incubation period

A

time between encountering bug and symptom onset

36
Q

what is the prodromal period

A

early signs of symptoms before actual signs

37
Q

what is DIC

A

disseminated intravascular coagulation, comp of sepsis

38
Q

what is the red flag for acute kidney injury in sepsis

A

oligurea

39
Q

what is the management of pyomyositis

A

urgent surgical debridement + 6wk IV ABx

40
Q

what is a complication of pyomyositis

A

septic emboli caused pneumonia and endocarditis

Y2 CLASP (6 decks)

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