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Year 2 - CLASP > Sepsis > Flashcards

Sepsis Flashcards

1
Q

Define the following terms:

  • Colonisation
  • Infection
  • Bacteraemia
  • Sepsis
  • Septic shock
A

Colonisation - the presence of a microbe in the human body without an inflammatory response

Infection - Inflammation due to a microbe

Bacteraemia - the presence of viable bacteria in the blood

Sepsis - the dysregulated host response to infection, resulting in life-threatening organ dysfunction

Septic shock - subset of sepsis with circulatory and/or metabolic dysfunction, and carries a much higher risk of mortality. NB - by definition, septic shock cannot occur prior to resus, as resus must have been attempted and the patient fail to respond

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2
Q

What diagnostic tools exist to establish whether or not a patient is septic?

A

SIRS (fallen out of favour)

NEWS-2

qSOFA

NICE guidelines

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3
Q

Sepsis 6 - what are they?

A

Give 3, Take 3

Give

  • Oxygen
  • Fluid resuscitation
  • Stat IV antibiotics

Take

  • Bloods for culture
  • Lactate, FBC and biochemistry urgently
  • Urine, and monitor urine output
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4
Q

Why is SIRS not thought to be useful?

A

Not everyone that SIRS clarifies as septic will be infected/be septic, SIRS is too sensitive and not specific enough

SIRS may also detract from the search for an infection in a patient

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5
Q

What are the parameters used in qSOFA? What is it used to predict?

A

RR > 22 bpm

sBP < 100 mmHg

Altered GCS

Used to predict morality - if one of the above then mortality = 2-3%, if 2 or more of the above then mortalitly is +10%

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6
Q

A NEWS score of what means that a diagnosis of sepsis should be considered?

A

A NEWS score greater than 5

Higher the number = higher the rate of mortality

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7
Q

What is the new simplistic way of thinking that a diagnosis of sepsis could be possible, related to NEWS?

A

Does the patient look ill?

Are they triggering an early warning score?

Are there signs of infection?

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8
Q

At what points are the NEWS trigger thresholds set?

A

1-4

3 in a single parameter

5 or more is urgent response threshold

7 or more is emergency response threshold

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9
Q

What types of fluid can be given in fluid resus for sepsis?

A

Crystalloids

Colloids

Albumin

Blood

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10
Q

How is fluid resus done in treating sepsis?

A

Initially fluid challenge with bolus of 500ml, followed by 30ml/kg and monitor response.

Continue to reassess and monitor urine on an hourly basis

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11
Q

What is the standard amount of fluid that is given to patients?

A

30 ml per kg of bodyweight

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12
Q

What is the minimum amount of urine you would want to see from a patient?

if less than this, what could this indicate?

A

At least 0.5ml per kg of bodyweight per hour

Less than this could indicate hypoperfusion of kidneys

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13
Q

How might a raised lactic acid level present in patients?

A

Raised lactic acid can result in lactic acidosis, the body will try to compensate by blowing off excess CO2 to restore normal pH = rapid shallow breathing

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14
Q

What further treatments can be given to restore normal BP?

What MAP is aimed for to ensure organ perfusion?

A

Inotropes/Vasoconstrictors - noradrenaline (alpha agonist), adrenaline (mixed alpha and beta agonist)

a minimum MAP of 65 mmHg is aimed for

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15
Q

What % of the population is genuinely allergic to penicillin?

A

Less than 0.05%

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16
Q

Give some examples of beta lactams

A

Penicillin

Flucloxacillin

Amoxicillin (a.k.a. Ampacillin - almost identical)

Cephalosporins

Piperacillins/tazobactam

Carbapenems

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17
Q

What is the only one of the cephalosporins that is active against Pseudomonas?

A

Ceftazadime

18
Q

How does Clavulanic acid help against beta lactamases?

A

Helps to inhibit the beta lactamase of bacteria, allowing the penicillin to work

19
Q

What is the only class of drug that is effective against ESBLs?

A

Carbapenems

20
Q

Name some gram negative bacilli

A

Coliforms

Psudomonas

H pylori

H. influenzae

Klebsiella

21
Q

In sepsis, a bacteriostatic/bacteriocidal antibiotic is given.

how are these defined?

A

Bacteriocidal

if there is more than a 1000-fold decrease in bacteria then it is classed as bacteriocidal

22
Q

What needs to be kept in mind when prescribing dose for beta lactams?

A

Regular doses are required to ensure the dose remains above the MIC

23
Q

Which gram negative bacilli is NOT killed off by ceftriaxone?

A

Pseudomonas

24
Q

What important question should you remember to ask a patient presenting with a likely sepsis when considering what treatment to prescribe (other than allergies!)?

A

Have you been on holiday recently? Worry about ESBLs!

25
Q

Mark is admitted to hospital with fevers, a swollen thigh, a discharging right groin wound and a cough over the preceding two days.

He injects heroin into his thigh. He always uses the needle exchange.

He has a fever of 39 degrees, BP 90/60, pulse 130 bpm. He is confused but has no focal neurology. RR is 28 and he has a newly raised creatinine. What test would you like to perform next, out of the following…?

- CT abdomen and pelvis

- CT Brain

- MRI Brain

- Echocardiography

A

Echocardiography

26
Q

Which of the following antibiotics have an antitoxin effect?

  • Flucloxacillin
  • Piperacillin-tazobactam
  • Linezolid
  • Vancomycin
  • Clindamycin
A

Linezolid and Clindamycin both have antitoxin effects

27
Q

Which of the following antibiotics is likely to be reliably active against ESBL producing coliforms in the blood?

  • IV piperacillin-tazobactam
  • IV meropenem
  • IV amoxicillin
  • IV flucloxacillin
  • IV co-amoxyclav
A

IV meropenem (only antibiotic effective against ESBLS are the carbapenems)

28
Q

When seeing a patient presenting with a likely E. coli infection (i.e. recent contact with animals, recently attended a barbecue, recent onset of bloody diarrhoea), why should antibiotics NOT be given?

A

Because of the risk of Haemolytic Uraemic Syndrome

29
Q

What drugs make up the 4Cs?

A

Co-amoxyclav

Cephalosporins

Clindamycin

Ciprofloxacin (and all other quinolones)

NB - all antibiotics are capable of leading to C diff infection, the 4Cs just carry the highest risk

30
Q

If a patient presents with infective endocarditis, how long will they need to be on antibiotic therapy for?

A

6 weeks

31
Q

Where are anaerobes typically found? What diseases might they lead to? What is the standard treatment for anaerobes

A

Found in the mouth, teeth, throat, sinuses and lower bowel, considered ‘dirty’ organisms

May lead to abscesses, dental infections, peritonitis or appendicitis

Typically treated with metronidazole

32
Q

Where are gram positive organisms typically found? What conditions might they cause?

What class of antibiotic is the treatment of choice when generally dealing with gram positive organisms?

A

Found on skin and mucus membranes

May cause pneumonia, sinusitis, cellulitis, osteomyelitis, wound infection and line infections

Penicillins are the treatment of choice for gram positives

33
Q

Name an antibiotic that ONLY treats gram positives

A

Vancomycin

34
Q

Where are atypical organisms usually found? What conditions can they cause?

What group of patients do they pose the biggest problem in?

A

Atypicals are usually found in the chest or genito-urinary system

They can cause pneumonia, urethritis and pelvic inflammatory disease

Atypical organisms cause the most issues for immunocompromised/immunosuppressed individuals

35
Q

Where are gram negative organisms typically found? What conditions can they cause?

What is the treatment of choice for gram negatives?

A

Typically found in the GI tract

Can cause UTIs, peritonitis, biliary infections, pancreatitis and pelvic inflammatory diseases.

Gentamicin is the treatment of choice.

36
Q

What infections would an HIV patient be susceptible to at the following CD4 cell counts…

  • CD4 <350
  • CD4 <200
  • CD4 <100
A

<350 - Mycobacterium tuberculosis, Candidiasis

<200 - Pneumocystis jirovecii, Toxoplasma gondii

<100 - Cryptococcus neoformans, CMV

37
Q

Name some diseases caused by spirochetes

A

Syphilis

Lyme disease

38
Q

Name some Alpha-haemolytic Strep

A

Strep pneumoniae

Strep viridans

39
Q

Name some Beta-haemolytic Strep

A

Group A Strep (S. pyogenes)

Group B Strep

40
Q

Name a Non-Haemolytic Strep

A

Enterococcus

Year 2 - CLASP (1 decks)

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