Sepsis

Question 1

Sepsis

Answer 1

Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection. Sepsis clinical criteria: organ dysfunction is defined as an increase of 2 points or more in the Sequential Organ Failure Assessment (SOFA) score.

• due to infection

Question 2

pathophysiology of sepsis -

what are the interleukins involved

Answer 2

• Complex interaction between the pathogen and immune system (TNF- ⍺, IL-18, IL-1B)
• Inflammatory response: vasodilation, increased vascular permeability, migration of WBC)
• Endothelial barrier compromised
• Hypotension, tissue hypoperfusion

Question 3

What is septic shock

Why is serial lactate needed?

Answer 3

Septic shock is cardio-circulatory failure - sudden drop in bp - septic shock - several organ stop functioning sequentially. This is multi-organ failure = death.

Question 4

what happens when E coli is identified by monocytes

Answer 4

Question 5

End- organ damage in sepsis

what occurs

Answer 5

• ARDS • Cardiomyopathy • Acute kidney injury • Cholestasis • Coagulopathy • Delerium/ encephalopathy • Bone marrow suppression • Myopathy

Question 6

What causes sepsis

What are the most common courses of sepsis?

Answer 6

•Bacteria • Viruses(dengue) • Fungi • Parasites(malaria)

Question 7

Who gets sepsis?

Answer 7

Anyone can. •

Groups more at risk: • Very young • Very old

• Immunosuppressed (chemotherapy, cancer, those on immunosuppressive therapies)
• Those with chronic diseases
• Post surgery

Question 8

What causes necrotizing fasciitis

Answer 8

Group A streptococcus usually

Question 9

What is this and what score would you escalate?

Answer 9

NEWS2 score

Escalate with score >5

or >3 with high suspicion

Question 10

When is SOFA score used and what does it predict

What does Q-Sofa use and what is it predictive of?

Answer 10

SOFA score used in ITUs- predicts mortality

Q-SOFA score – simple and predictive - altered mental status, high RR, low BP

Question 11

What are symptoms of sepsis

Answer 11

Question 12

What is SEPSIS 6 and when should it be given?

Answer 12

Give 3 and take 3 within the HOUR

1. Antibiotic IV - according to trust guideline
2. Oxgen - target >92%. (careful COPD-88-92) - 15L O2 non rebreath
3. IV fluid - at least fluid bolus (500ml crytalloid with 130-154mmol/L sodium over 15min 0.9% saline). After 2 bolus - speak to senior
4. Blood cultures, urine cultures, U+e, FBC, LFT, clotting, imaging
5. lactate (ABG)
6. Look at urine output (catheterise)

Question 13

how is sepsis monitored and how often?

Answer 13

hourly obs

urine output

gcse

Question 14

What are post sepsis symptoms

Answer 14

• ITU admission brings risks (healthcareassociated infections, myopathy)
• Prolonged immune-suppressive phase in sepsis
• Psychological effects can be disabling

Question 15

Sepsis prevention is done how?

Answer 15

Vaccinations

• Hand hygiene
• Prevention of healthcare-associated infection
• Public awareness