Sepsis Flashcards
1
Q
What is sepsis?
A
- life threatening organ dysfunction caused by dysregulated host response to infection
- combination of Systemic Inflammatory Response Syndrome (SIRS) + infection
- sepsis -> severe sepsis -> septic shock (hypotension + low serum lactate, despite intervention)
2
Q
What does qSOFA indicate?
A
- patients who are likely to have prolong ICU stay or die
- hypotension (systolic BP < 100mmHg)
- altered mental status
- tachypnoea (RR > 22/min)
- 2/3 = greater risk of poorer outcome
3
Q
What is the pathophysiology of sepsis?
A
- uncontrolled inflammatory response
- similar to immunosupression:
- loss of delayed hypersensitivity
- inhability to clear infection
- predisposition to nosocomial infection
- later anti-inflammatory immunosuppressive phase
4
Q
What is the 1 of 3 phase of sepsis?
A
Release of bacterial toxins
- lipopolysaccharides (Gram -ve)
- Microbial Associated Molecular Pattern (MAMP) (Gram +ve)
- lippteichoic acid
- muramyl dipeptides
- superantigens (Gram +ve)
- staph toxic shock syndrome toxin (TSST)
- strep exotoxins
5
Q
What is the 2 of 3 phase of sepsis?
A
- effects of endotoxin + exotoxin release
- mediator role on sepsis
- pro-inflammatory mediatory cause inflammatory response
- compensatory anti-inflammatory response cause immunoparalysis
6
Q
What is phase 3 of 3 of sepsis?
A
- pro-inflammatory mediators
- endothelial cell- leukocyte adhesion
- release arachidonic acid metabolites
- compliment activation
- vasodilation by NO
- release of tissue factors + membrane coagulants -> inc. coagulation
- hyperthermia
- anti-inflammatory mediators
- inhibit TNF alpha
- augment acute phase reaction
- inhibit activation of coagulation system
- give -ve feedback to pro-inflammatory mediators
7
Q
What do the clinical features of sepsis depend on?
A
- host
- organism
- environment
8
Q
What are general features of sepsis?
A
- fever
- hypothermia (esp. elderly, very young, immunosuppressed)
- tachycardia
- tachypnoea
- altered mental status (esp. elderly)
- hyperglycaemia
9
Q
What are inflammatory variables in sepsis?
A
- leukocytosis
- leukopenia
- normal WCC
- high CRP
- high procalcitonin
10
Q
What are haemodynamic variables in sepsis?
A
- arterial hypotension
- SvO2 > 70%
11
Q
What are organ dysfunction variables in sepsis?
A
- arterial hypoxaemia
- oliguria
- inc. creatinine
- coagulation abnormalities
- ileus
- thrombocytopenia
- hyperbilirubinaemia
12
Q
What are tissue perfusion variable in sepsis?
A
- high lactate
- skin mottling + dec. capillary perfusion
13
Q
What is the “sepsis 6” management for sepsis?
A
Take:
- blood cultures
- blood lactate
- measure urine output
Give:
- oxygen (aim 94-98%)
- IV antibiotic
- IV fluid challenge
14
Q
When should patient be referred to HDU?
A
- low BP responsive to fluid
- lactae > 2 despite fluid resuscitation
- inc. creatinine
- oliguria
- liver dysfunction
- bilateral infiltrates, hypoxaemia
15
Q
When should a patient be referred to ITU?
A
- septic shock
- multi-organ failure
- requires sedation, intubation + ventilation
