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BDS2 BAMS Sepsis > Sepsis > Flashcards

Sepsis Flashcards

1
Q

What are the misconceptions of sepsis

A

it is an infection of the blood

blood poisoning

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2
Q

what is sepsis

A

ife threatening organ dysfunction due to a dysregulated host response to infection

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3
Q

what is sepsis triggered by

A

by infection (in susceptible patients) but it is not the microorganism that is causing the pathology

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4
Q

what is it that causes organ dysfunction

A

It is the overwhelming immune response that causes organ dysfunction

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5
Q

what differentiates sepsis and infection

A

it is the presence of organ dysfunction differentiates sepsis from infection

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6
Q

what is sepsis 3

A

Sepsis-3 is the third international consensus definition for sepsis and septic shock

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7
Q

how is organ dysfunction identified

A

can be identified as an acute change in total SOFA score of greater than 2 points

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8
Q

What is sepsis shock

A

Sepsis shock is sepsis in which the underlying circulatory and cellular and/or metabolic abnormalities are marked enough to substantially increase mortality

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9
Q

what is sepsis shock defined as

A
  • It is clinically defined as sepsis with persisting hypotension that requires vasopressors to maintain the mean arterial pressure at 65mmHg and with a serum lactate concentration of greater than 2moll-1
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10
Q

what is qSOFA

A

It is a tool used to clinically characterize patients at risk of sepsis (at risk of prolonged ICU or death)

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11
Q

what is the advantage of qSOFA

A

SOFA does not require lab tests

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12
Q

what is the criteria for the quick SOFA

A
  • Respiratory rate greater than or equal to 22 breaths/minute
  • Altered mentation (Glasgow coma scale < 15)
  • Systolic blood pressure less than or equal to 100mmHg
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13
Q

what is the baseline SOFA

A

0 unless patient has pre-existing organ dysfunction BEFORE onset of infection

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14
Q

What does it mean if the qSOFA is equal to or greater than 2

A

If the qSOFA is equal to or greater than 2 then there is an overall 10% mortality risk – requires prompt medical intervention

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15
Q

what is the criteria of glasgow coma scale

A
  • Eye opening
  • Verbal response
  • Best motor response
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16
Q

what causes sepsis

A

Any infection can trigger sepsis

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17
Q

what are the common sites of infection which lead to sepsis

A
  • Lungs (64%)
  • Abdomen (20%)
  • Blood stream (15%)
  • Urinary system (14%)
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18
Q

what is the most common sources of infection

A

gram positive bacteria - staph aureus
gram negative bacteria - most common
fungal (candida)

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19
Q

what are candida blood stream infections associated with

A

higher ICU mortality compared with bacterial infections

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20
Q

what are the microbial factors that lead to progression of sepsis

A 
-	Virulence factors
o	LPS
o	Lipoteichoic acid
o	Peptidoglycan 
o	Pili, fimbriae, capsule ect
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21
Q

what are the host factors that lead to the progression of sepsis

A
  • Innate immunity
  • Adaptive immunity
  • Immune-compromised
    o HIV/AIDs, cancer, autoimmunity, organ transplantation
  • Preexisting chronic conditions
    o Diabetes, cirrhosis, CKD
  • Age
  • Genetics
22
Q

what does a weakened/compromised immune response result in

A

microbial colonization gives a competitive advantage

23
Q

who gets sepsis

A

it is most common among the aging population

24
Q

what are examples of medically and immune compromised patients which can resulting increased risk for sepsis

A
  • Cancer
  • Cirrhosis
  • Autoimmunity
  • HIV/AIDS
  • Organ transplantation
  • Diabetes
25
Q

what is the pathophysiology of sepsis

A

Dysregulated, excessive systemic inflammation
Body-wide blood clotting and ‘leaky vessels’
One or more organs begin to fail (sepsis – 10% in hospital mortality)
In persistent hypotension (septic shock – 40% in hospital mortality)

26
Q

what kicks off the protective immune reaction

A

invading microorganisms or endogenous signals from damaged cells

27
Q

what does the protective immune system give rise to

A

to cardinal signs of inflammation – localized to the site of infection

28
Q

What should acute inflammation lead to

A

clearance of the source of injury and necrotic tissues

Followed by tissue repair and return to homeostasis

29
Q

what is the immune system activated by

A

PAMPs and DAMPs

30
Q

what is the process of the immune response

A
  • Innate immune system recognizes PAMPs (and DAMPs) through PRRs
  • Responding cells trigger inflammation through release of cytokines and chemokines
  • Cytokines activate endothelial cells, vasodilation and vascular permeability so that the immune cells can move out from the blood and into tissue to remove infection and remove dead tissue and return tissue to health
  • Large amounts of cytokines (e.g TNFa) activate acute phase proteins in the liver, platelet activation and symptoms of fever
  • Activation of complement
31
Q

what are the anti-inflammatory mediators that result in immune suppression

A

IL-10

TGF-B

32
Q

what happens in sepsis in relation to the pathogen

A

the immune response fails to eliminate the pathogen

Localized acute inflammation progresses to acute systemic inflammation

33
Q

what do patients with sepsis demonstrate

A

excessive inflammation AND immune suppression

34
Q

what does excessive inflammation result in

A
  • Tissue injury
  • Strong activation of innate immunity via PAMPs and DAMPs
  • Sustained hyperinflammation
  • Activation of complement system, coagulation system and vascular endothelium
35
Q

what happens in immune suppression

A
  • Immune suppression of both innate and adaptive immunity
  • Apoptosis of T cells, B cells
  • Dysfunctional DCs
  • Delayed apoptosis of immature dysfunctional neutrophils
36
Q

What are the main sites of organ dysfunction

A

Main sites are CVS system and blood coagulation system

37
Q

What is done for treating sepsis

A
  • Antibiotics (early administration)
  • Vasopressors
  • Enteral feeding
  • Insulin therapy
  • Lung protective ventilation
  • Urinary catheter
  • Fluids (colloids and crystalloid
38
Q

what is the aim of treatment in sepsis

A

The treatment for the signs and symptoms and keeping the patient alive not the cause of sepsis because we don’t know enough about why it happens

39
Q

what is the relevance to dentists

A

Sepsis is a rare but potentially serious complication of acute dental infections

40
Q

what is a source of infection within the mouth

A

Caries is a source of infection, secondary consequence is abscess and can be a cause of sepsis

41
Q

what factors make dental abscesses a risk factor for sepsis

A
  • They are able to erode into the neck or floor of mouth.

- They can spread as there is live bacteria in the abscess

42
Q

What are dental abscesses a consequence of

A

consequence of acute inflammatory response to bacterial infection
contain a pus which contain immune cells, dead tissue and LIVE bacteria
It is highly infectious.

43
Q

how should abscesses be treated

A

It should be treated promptly by excision and drainage. Periapical abscesses require root canal or extraction.

44
Q

how can abscesses spread

A

The abscess can spread into the mouth resulting in a salty taste
It can also develop fistula and drain out of the cheek
They can spread into the floor of the mouth, neck and even the blood stream

45
Q

what are red flags of a spreading dental infection

A
  • Temp <36 or >38
  • Elevated breathing rate (>20 breath/min)
  • Elevated or reduced heart rate
  • Varying degrees of facial swelling
  • Trismus
  • Dehydration
46
Q

What is the impact of the dendritic cells being dysfunctional

A

they are unable to present the antigen to the immune system

47
Q

What is SIRS

A

Systemic inflammatory response syndrome (SIRS), is an inflammatory state affecting the whole body

48
Q

How is SIRS diagnosed

A

temperature
heart rate
respiratory rate
WBC

49
Q

What is the difference with qSOFA and SIRS diagnosis

A

qSOFA and SIRS both look at the respiratory rate

qSOFA looks at mentation and systolic blood pressure as well, SIRS doesn’t

50
Q

What should be done if someone with dental infection meets SIRS criteria

A

tx should be given tor reduce risk of sepsis

51
Q

What should be done if someone with dental infection is showing signs of organ dysfunction

A

this is a medical emergency

BDS2 BAMS Sepsis (1 decks)

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