Sepsis

Question 1

What is sepsis?

Answer 1

Life-threatening organ dysfunction caused by the dysregulated host response to infection.

Question 2

Pathophysiology:

What type of shock does it cause?

Why does DIC occur in sepsis?

Answer 2

Distributive shock - due to vasodilation

Sepsis-induced DIC. During sepsis, inflammation diffusely activates the coagulation system, consuming multiple clotting factors and resulting in DIC.

Question 3

Sepsis recognition:

What type of patient should you have a low threshold for sepsis?

Answer 3

Those who have communication difficulties
Immunosuppressed, chemo or IVDU
Recent surgery, pregnancy
Indwelling lines/other foreign materials

Question 4

SIRS criteria:

What does it stand for:

What are the 4 components of this criteria?

Answer 4

Systemic inflammatory response syndrome

Temp
WBC
HR
RR

Question 5

SIRS criteria:

Temp - what is the normal range?

WBC - what is the normal range?

Over what HR?

Over what RR?

There are 4 components in these criteria. How many does a patient need to have to be classed as fulfilling this criteria?

If a patient reaches this criteria, what else do they need to diagnose them with sepsis?

What in addition to sepsis would need to occur before it is classed as severe sepsis?

What in addition to

Answer 5

RR>20

36-38*

4-12

HR>90

2 or more

SIRS + signs of infection (e.g. Fever, Focal crackles/bronchial breathing on chest auscultation)

Sepsis + organ hypoperfusion and dysfunction

Question 6

SIRS criteria:

What else can cause SIRS?

Answer 6

Trauma
Burns
Pancreatitis
Any form of stress or exertion

Question 7

Septic Shock:

Above what lactate levels is classed as septic shock?

If a patient requires ______ to maintain MAP >65 mmHg, then they have septic shock. Fill the gap

Answer 7

> 2 mmol/L

Vasopressors

Question 8

S+S:

What abnormal OBS do you expect to see? - 3

What skin and peripheral changes would you see?

Answer 8

Low BP
High HR
High RR

Prolonged cap refill 
Warm and sweaty 
Cold peripheries 
Molted skin - look up 
Petechial rash

Question 9

Management:

SEPSIS 6 - 3 IN 3 OUT - What does it stand for?

Why may the following bloods be done:

• U&E
• LFT
• Coag

Within what time does Rx need to be commenced?

Answer 9

Antibiotics
Fluids
Oxygen

Culture 
Urine output 
Lactate  
=====
AKI

Liver dysfunction

DIC

1 hr

Question 10

Management:

Antibiotics:

• Broad spec antibiotics are given until cultures arrive back. What are 2 examples of this?
• What could you use if a viral infection is suspected?

Further treatment:
- Vasopressors - what is usually given? why is this given?

Answer 10

Give aciclovir - if HSV encephalitis

Piperacillin
Tazobactum

Adrenaline

For fluid-refractory shock