Sepsis

Question 1

what is the definition of sepsis?

Answer 1

Life threatening organ dysfunction caused by a dysregulated host response to infection

Question 2

what is septic shock?

Answer 2

a subset of sepsis with profound circulatory, cellular and metabolic abnormalities, associated with greater risk of mortality than sepsis alone

Question 3

what are the red flags of sepsis?

Answer 3

Using A-E approach

A
- resp rate >25/min

B
- new need for >40% O2 to keep saturations over 91% (>87% in COPD)

• systolic BP <91 mmHg or fall of 40 from normal

C
- HR >130/min

• no urine output for 16hrs or UO <10ml/hr

D
- new onset delirium

• responds to only voice/pain/unresponsive

E
- non blanching rash/mottled/ ashen/ cyanotic

• neutropenia or chemotherapy within last 6 weeks

Question 4

what is the sepsis 6?

Answer 4

Give
- oxygen (sats >94%, in COPD 88-92%)

• IV antibiotics, meropenem IV 1g stat (+/- second dose at 8hrs)
• Fluid challenge (500mls Hartmanns or 0.9% NaCl over 15 minutes)

Take
- serum lactate (>4mmol, refer to critical care)

• urine output (catheterise and commence hourly fluid balance chart)
• blood cultures and source management

Question 5

what is the antibiotic choice for the common skin/soft tissue infective organisms

1) staphylococci
2) streptococci
3) penicillin allergies to the above
4) MRSA

Answer 5

1) Flucloxacillin
2) benzylpenicillin/fluclox

3) tetracycline (doxycycline)
carbapenem (meropenem)
cephalosporin (ceftriaxone)

4) glycopeptide e.g vancomycin

Question 6

what is the antibiotic choice for the common MSK infective organisms

1) mixed in diabetic foot infections e.g pseudomonas sp, enterobacteriacae
2) TB

Answer 6

1) broad spectrum e.g penicillin, carbapenem

2) quadruple therapy

Question 7

what is the antibiotic choice for the common hospital acquired infections

1) enterobacteriacae e.g E.coli, Klebsiella spp.
2) pseudomonas spp.
3) C. difficile

Answer 7

1) co amoxiclav
2) ciprofloxacin, Gentamicin
3) metrondiazole/ Vancomycin

if severe/ multi drug resistant, tazocin/carbapenem

Question 8

what is the antibiotic choice for the common causative organisms of endocarditis

1) streptococci
2) enterococci
3) staph aureus
4) culture - endocarditis
5) MRSA/Pen allergy

Answer 8

1) benxylpenicillin +/- gent
2) amoxicillin +/- gent
3) flucloxacillin +/- gent +/- rifampicin
4) ceftriaxone
5) vancomycin

Question 9

what is the antibiotic choice for MRSA causing line infections

Answer 9

vancomycin

Question 10

what is the antibiotic choice for the CNS infection causitive organisms

1) streptococci
2) Neiserria
3) Listeria
4) penicillin allergy
5) HSV

Answer 10

1+2 ) cephalosporin (ceftriaxone)

give dexamethasone with 1st dose in bacterial meningitis

3) IV amoxicillin
4) meropenem
5) aciclovir

Question 11

what is the antibiotic choice for GU tract infective organisms

1) enterobacteriacae e.g e coli, klebsiella
2) pseudomonas aerogenosa
3) gonorrhoea
4) chlamydia trachomatis

Answer 11

1) mild = trimethoprim, mod-severe = co amoxiclav
2) ciprofloxacin, gent, tazocin
3) ceftriaxone
4) azithromycin

Question 12

what is the antibiotic choice for GI tract infective organisms

1) campylobacter, shigella, e coli

Answer 12

1) usually nil, if severe ciprofloxacin, macrolide e.g clarithromycin, azithromycin

Question 13

what is the antibiotic choice for the respiratory infective organisms

1) streptococci
2) H influenzae
3) atypical e.g legionella, mycoplasm

Answer 13

1) penicillin (amoxicillin)
2) co amoxiclav
3) doxycycline