Sepsis

Question 1

What is the definition of sepsis?

Answer 1

Life-threatening organ dysfunction caused by a dysregulated response to infection, it is identified as a qSOFA score of more than 2

Question 2

What is the definition of septic shock?

Answer 2

Sepsis with persistent hypertension requiring vasopressors to maintain the MAP >65mmHg and having a high serum lactate

Question 3

What is SIRS?

Answer 3

Systemic Inflammatory Response Syndrome 
Required 2 of the following:
1. Temperature over 38 or under 36.2
2. HR above 90
3. Respiratory rate over 20
4. PaCO2 under 32.5
WBC's greater than 12'000 or less than 4000

Question 4

What is the definition of bacteraemia?

Answer 4

Presence of bacteria in the bloodstream

Question 5

What is the definition of septicaemia?

Answer 5

This is the presence of a pathogen within the bloodstream that could lead to sepsis?

Question 6

What is the definition of Severe shock?

Answer 6

SIRS + End Organ Damage

Question 7

What 3 criteria make up the qSOFA score?

Answer 7

Hypotension >100mmHg
Altered mental staus
Tachypnea RR >22/min

Question 8

What is the pathogenesis of sepsis?

Answer 8

There is breach of the hosts barrier mechanism
Release of the organism into the bloodstream leading to an uncontrolled inflammatory response and the inability to clear infection, this causes 3 things:
1. Release of bacterial toxins
2. Release of Pro-inflammatory mediators mediators
3. Effects of specific excessive mediators ie anti-inflame mechanisms

Question 9

What re the general features of sepsis?

Answer 9

Fiver over 38oC
Chills
Rigors
Cold/ night sweats 
Hypothermia under 36oC
Alterend mental status 
Hyperglycaemix 
Leucocytosis 
Leukopenia 
Tachycardia

Question 10

What are the signs of organ dysfunction?

Answer 10

Altered consciousness/ confusion 
Tachypnea
Jaundice, increased LFT's
Tachycardia
Hypotension 
Oliguria, anuria increased creatinine
Low platelets, low protein C, high D-dimer

Question 11

What are the risk factors for sepsis?

Answer 11

Immunosuppression
Splenectomy
Environmental risk ie occupation, travel and hospitalisation

Question 12

What is the SINGLE most important blood test in sepsis?

Answer 12

LACTATE

Question 13

What is the sepsis 6?

Answer 13

Take 3
Blood cultures
Blood lactate(blood gas) show hypo perfusion 
Urine output 
Give 3
Oxygen - aim for sats of 94-98%
IV antibiotics 
IV fluid challenge(HARTMAN"S)

Question 14

What will the FBC show in sepsis?

Answer 14

Leucocytosis (WCC > 12,000/ml)
Leucopenia (WCC < 4,000/ml)
Normal WCC with greater than 10% immature forms
High CRP
High procalcitonin
Procalcitonin better than CRP

Question 15

What are the indications for transfer to HDU?

Answer 15

Low BP unresponsive to fluids 
Lactate >2 despite fluid recitation 
Increased creatinine 
Oliguria 
Liver dysfunction 
Bilateral infiltrates

Question 16

When are you going to send a patient to ITU?

Answer 16

Septic shock
Multi-organ failure
Sedation, intubation or ventilation

Question 17

What re some of the causative organism of sepsis and their origins?

Answer 17

Skin = SA
Resp = Strep Pyogenes
GI = E.coli
IV catheter = Candida Albicans

Question 18

Give the general definition of shock

Answer 18

Acute circulatory failure
Inadequate or inappropriate perfusion
Generalised cellular hypoxia

Question 19

What characteristics of septic shock are not present in SIRS?

Answer 19

Evidence of infection
Organ hypo perfusion
Hypotension despite adequate fluid resuscitation

Question 20

Name 1 gram negative organism that can cause septic shock

Answer 20

E.coli

Question 21

What component of a gram negative organism causes septic shock

Answer 21

LPS / Endotoxin

Question 22

Name one component of a Gram positive organism that is thought to be involved in the development of septic shock

Answer 22

Superantigens

Cell wall/peptidoglycan