Sepsis

Question 1

What is the sepsis six?

Answer 1

Blood culture 
Urine output 
Fluid resus
Antibiotics
Lactate
Oxygen

Question 2

What is the definition of sepsis?

Answer 2

Presence of infection together with systemic manifestation of infection - tachycardia, pallor, pyrexia, raised infection markers

Question 3

What is the definition of severe sepsis?

Answer 3

Sepsis PLUS sepsis-induced organ dysfunction or tissue hypoperfusion - low urine output, changes in blood clotting, raised bilirubin, raised lactate

Question 4

What is the definition of septic shock?

Answer 4

Sepsis induced hypotension persisting despite fluid resus - systolic BP 90mmHg or MAP 70mmHg

Question 5

What are the markers of oxygen?

Answer 5

Lactate

Venous oxygen sat

Question 6

What are the risk factors for sepsis?

Answer 6

Immunocompromised 
Neonates and infants 
Chronic disease 
Recent surgery 
Invasive procedures

Question 7

Describe the pathophysiology of sepsis

Answer 7

Deregulated inflammatory response
Release of inflammatory cytokines - TNF, IL-1 and IL-6
Nitric oxide release -> vasodilation -> reduction in vascular resistance -> hypotension
Endothelial activation -> capillaries become porous
Hypovolaemia

Question 8

The lowest dose of empirical antibiotic is given for the shortest duration while blood cultures are obtained. True or false?

Answer 8

False - max dose, max frequency

Question 9

Empirical antibiotics are given that cover g+ and g- to start with. What groups of ABs?

Answer 9

3rd gen cephalosporins

Macrolides - if penicillin allergic

Question 10

What groups of ABs are given for neutropenia?

Answer 10

Broad spec penicillin

Add in aminoglycoside

Question 11

What AB is given for acute abdominal infection?

Answer 11

Add in metronidazole

Question 12

Which ABs are given if culture shows infection is caused by staph?

Answer 12

Flucloxacillin
Rifampicin
Vancomycin (if MRSA)

Question 13

Which ABs are given if infection caused by coliforms?

Answer 13

Co-amoxiclav

Carbapenems

Question 14

Which AB is given if psued caused infection?

Answer 14

Ceftazidime

Question 15

What needs to be completed in the first 3 hours of admission?

Answer 15

Measure lactate
Blood culture before giving AB
Broad spec AB given
Administer 30ml/kg crystalloid for hypotension or if lactate >4 mmol/L

Question 16

What needs to be completed within 6 hours?

Answer 16

Apply vasopressors for hypotension that doesn’t respond to fluid resus to maintain MAP >65
Septic shock or initial lactate >4mmol/L measure CVP and central venous oxygen sat
Remeasure lactate if initial lactate elevated

Question 17

In the NICE stratification what is the high risk criteria for respiration?

Answer 17

> 25 breaths/min

O2 needed to maintain sat >92%

Question 18

In the NICE risk stratification what is the high risk criteria for BP?

Answer 18

Systolic BP of 90mmHg or less

Question 19

In the NICE risk stratification what is the high risk criteria for circulation and hydration?

Answer 19

Not passed urine in previous 18hrs

HR >130 bpm

Question 20

In the NICE risk stratification what is high risk criteria for skin?

Answer 20

Mottled or ashen appearance

Cyanosis of skin, lips or tongue

Question 21

In the NICE risk, a raised RR of 21-24 indicates which level of risk?

Answer 21

Moderate/high

Question 22

A systolic BP of 91-100 mmHg indicates which level of risk in NICE stratification?

Answer 22

Moderate/high

Question 23

What is the NICE stratification moderate/high risk criteria for circulation and hydration?

Answer 23

HR 91-130bpm and not passed urine for 12-18 hours

Question 24

What is the NICE stratification moderate to high risk criteria for skin?

Answer 24

Signs of potential infection - redness, swelling or discharge at surgical site