Sepsis

Question 1

Define Sepsis

Answer 1

Sepsis is a life-threatening organ dysfunction due to dysregulated immune response to infection.
Clinically its SIRS + a confirmed infection.

Essentially bacteria invade a sterile comparment e.g. blood or abdominal cavity and release endo/exotoxins leading to uncontrolled inflammatory resposne

Question 2

Define SIRS?

Answer 2

Systemic Inflammatory Response Syndrome.
A set of symptoms that occur during systemic inflammation e.g. infection, burns, trauma or pancreatitis.

2 or more from:

• High or low Temp
• Tachypnoea or Low PaCO2
• Tachycardia
• Leucocytosis or Leucopenia or >10% band cells (immature WCs)

Question 3

How do we assess a patient’s organ dysfunction when we suspect Sepsis?

Answer 3

SOFA score (Sepsis Organ Failure Assessment)
or qSOFA to identify patients at high risk or death/requiring ICU

Question 4

Whats included in qSOFA?

Answer 4

High risk is 2 or more of:

• Hypotension
• Altered Mental Status
• Tachypnoea

Question 5

Define Septic Shock?

Answer 5

Sepsis (i.e. infection + SIRS) along with refractory hypotension.
I.e. the hypotension requires vasopressors to maintain MAP >65mmHg and serum lactate remains >2mmol/l despite fluids.

Question 6

Inflammatory mediators released in response to infection can be pro/anti-inflammatory. What happens if there’s an excess of either?

Answer 6

Pro-inflammatory = Septic Shock -> Multi-organ failure and death

Anti-inflammatory = Immunoparalysis -> Uncontrolled infection -> Multi-organ failure and death

Question 7

How may sepsis present? Think about the different potential organ dysfunctions

Answer 7

Brain - Altered Mental Status
Lungs - Tachypnoea or Low O2
Heart - Tachycardia & Hypotension
Kidneys - Oliguria/anuria and high creatinine
Liver - Jaundice, raised enzymes, INR & bilirubin and low albumin
Systemic - Fever (and associated symptoms e.g. sweat, chills), hypothermia, hyperglycaemia, leucopenia/cytosis, thrombocytopenia, high CRP and +ve D-dimer (clotting)

Along with signs of source infection e.g. wound, peritonitis or pneumonia.

Question 8

What factors can effect how sepsis presents?

Answer 8

Host - Age, immunosuppression, co-morbidities or surgery
Organism - Virulence factors, bioburden & Gram +ve vs -ve
Environment - Occupation, travel & hospitalisation

Question 9

What tests can you run for Sepsis?

Answer 9

FBC
Glucose
U&E + Creatinine
LFTs
D-dimer & Coagulation study (sepsis causes hypercoagulation)
CRP

Question 10

How do you manage Sepsis?

Answer 10

With the Sepsis 6:
Give 3:
- IV fluid Challenge (30ml/kg/day) (if BP doesnt improve = shock)
- IV Abx (specific to suspected source & cultures)
- O2

Take 3:

• Blood cultures
• Serum Lactate type A (marker of hypoperfusion and poor clinical outcome)
• Urine output monitoring