Sepsis

Question 1

if there is a continuous bacteraemia what does this indicate

Answer 1

endovascular source of infection such as endocarditis or typhoid

Question 2

if there is an intermittent bacteraemia what does this indicate

Answer 2

focal infection releases showers of bacteria into the blood stream

Question 3

define sepsis

Answer 3

bodies systemic response to an infection which can result in multi organ failure (hypotension and icreased rr)

Question 4

what is severe sepsis

Answer 4

sepsis and organ dysfunction, hypoperfusion or hypotension

Question 5

what is septic shock

Answer 5

sepsis and hypotension despite fluid resuscitation

Question 6

how can you easily suspect sepsis

Answer 6

sews>4 and suspected infection

Question 7

what are the sirs criteria

Answer 7

RR>20 
altered mental status 
temp <36 or >38
known suspected neutropenia 
HR >90 
wbc <4 or >12

Question 8

how many of the sirs criteria indicates sepsis

Answer 8

greater than or equal to 2 and likely infection

Question 9

why is lactate increased and what do the numbers indicate

Answer 9

anaerobic metabolism due to decreased perfusion of tissues

>2 suspected >4 diagnostic

Question 10

what are the main signs of organ dysfunction in a septic patient?

Answer 10

systolic <90 (or 40 below patients normal)
urine output <30ml/hr for 2 hours
new need for oxygen to maintain stats
lactate >4
serum creatinine>150
newly altered mental status
unexplained coagulopathy/ thrombocytopenia

Question 11

what is the normal urine output?

Answer 11

> 0.5ml/kg/hr

Question 12

what does IVOST stand for?

Answer 12

IV to oral switch

Question 13

what are the main risk factors for endocarditis

Answer 13

congenital heart disease and iVDU

Question 14

what criteria is used for endocarditis

Answer 14

dukes criteria

Question 15

what are the major criteria for dukes

Answer 15

1. 2 separate blood cultures 30 mins apart with microorganisms typical of endocarditis
2. echo evidence of endocardial involvement
3. new valvular regurg

Question 16

what are the minor criteria for dukes

Answer 16

predisposition - congenital heart defect/ ivdu etc
vascular phenomena (septic emboli/ mycotic aneurysm etc) 
immunological phenomena (glomerulonephritis, oslers nodes, roth spots, rheumatoid factors) 
microbio evidence (pos blood cultures)

Question 17

what valves are typically affected in PWID endocarditis

Answer 17

right (tricuspid»mitral>aortic)

Question 18

what is the scoring system for dvt

Answer 18

wells score