Sepsis

Question 1

What is sepsis?

Answer 1

Systemic illness caused by microbial invasion of normally sterile parts of the body

Question 2

What is SIRS?

Answer 2

Temp <36 or >38
HR >90 bpm
RR >22 or PaCO2 32
WBCs <4,000 or >12,000

Question 3

What results from SIRS + infection?

Answer 3

Sepsis

Question 4

What constitutes severe sepsis?

Answer 4

Sepsis

End Organ Damage

Question 5

What is septic shock?

Answer 5

Sever sepsis

Hypotension

Question 6

What is qSOFA?

Answer 6

Identifies patients with suspected infection who are likely to have a prolonged ICU stay or die in the hospital

Systolic BP <100
Altered mental status
RR >22/min

Score of 2 or more indicates higher risk

Question 7

How much does mortality increase in sepsis for every hour that antibiotics are not administered?

Answer 7

7.6%

Question 8

What is the sepsis 6 bundle?

Answer 8

Give oxygen to keep sats above 94%
Blood culture
IV antibiotics
Fluids
Serum lactate
Monitor urine output

Question 9

What are the body’s physical barriers against sepsis?

Answer 9

Skin
Mucosa
Epithelial lining

Question 10

What are the body’s innate immune system barriers against sepsis?

Answer 10

IgA in GI tract
Dendritic cells
Macrophages

Question 11

What are the body’s adaptive immune system barriers against sepsis?

Answer 11

Lymphocytes

Immunoglobulins

Question 12

What are some features of sepsis consistent with immunosuppression?

Answer 12

Loss of delayed hypersensitivity
Inability to clear infection
Predisposition to nosocomial infection

Question 13

What are the 3 main stages in the pathogenesis of sepsis?

Answer 13

Release of bacterial toxins
Release of mediators
Effects of specific excessive mediators

Question 14

What are some commonly released bacterial toxins in sepsis?

Answer 14

Lipopolysaccharides
Lipoteichoic acid
Muramyl dipeptides
Staphylococcal toxic shock syndrome toxin (TSST)
Streptococcal exotoxins

Question 15

What happens when the pro-inflammatory immune response outweighs the compensatory anti-inflammatory response?

Answer 15

Septic shock with multi-organ failure and death

Question 16

What happens when the compensatory anti-inflammatory response outweighs the pro-inflammatory response?

Answer 16

Immunoparalysis with uncontrolled infection and multi-organ failure

Question 17

What are some general features of sepsis?

Answer 17

Fever/hypothermia
Tachypnoea
Altered mental status
Hyperglycaemia

Question 18

Is CRP elevated or reduced in sepsis?

Answer 18

Elevated

Question 19

Is procalcitonin elevated or decreased in sepsis?

Answer 19

Elevated

Question 20

What are some signs of organ dysfunction in sepsis?

Answer 20

Arterial hypoxaemia
Oliguria
Creatine increase
Coagulation abnormalities
Ileus
Thrombocytopenia
Hyperbilirubinaemia

Question 21

Why do we take blood cultures in sepsis?

Answer 21

Make microbiological diagnosis

Take 2 tests if there is a spike in temperature

Question 22

Why do we measure lactate in sepsis?

Answer 22

Indicator of generalised hypoperfusion

Indicates severe sepsis and so a poorer prognosis

Question 23

Why do we monitor urine output in sepsis?

Answer 23

Low urine output is an indicator of renal dysfunction

Question 24

How much fluid should we usually give

Answer 24

30ml per kg body weight