Sepsis Flashcards
Sepsis is NOT an infection. Can sepsis occur in the absence of an infection?
- No, sepsis does not occur in the absence of infection
What is sepsis?
- A life-threatening organ dysfunction due to a dysregulated host response to infection
What is sepsis triggered by?
- Triggered by infection in a susceptible patient)
- This causes an overwhelming immune response that causes organ dysfunction
- (presence of organ dysfunction differentiates sepsis from infection)
Is sepsis associated with a high risk of mortality?
- Yes
What 3 things need to be identified by qSOFA for someone to have sepsis?
- Respiratory > or equal to 22 breaths/min
- Altered mentation (Glasgow coma scale <15)
- Systolic BP < or equal to 100mmHg
What does SOFA stand for?
- Sepsis-related organ failure assessment
What is septic shock?
- A subset of sepsis
- Sepsis in which the underlying circulatory and cellular and/or metabolic abnormalities are marked enough to substantially increase mortality
- Clinically defined as sepsis with persisting hypotension that requires vasopressors to maintain the mean arterial pressure at greater than or equal to 65mmHg and with a serum lactate concentration of greater than 2mmoll-1
What is qSOFA?
A tool to clinically characterise patients at risk of sepsis
What should the baseline qSOFA score be?
Should be 0 unless a patient has a pre-existing organ dysfunction BEFORE onset of infection
What is the overall mortality risk for a patient with a qSOFA score of > or equal to 2?
Overall 10% mortality risk - requires prompt medical intervention
What are the 3 criteria you are looking for in the Glasgow coma scale?
- Eye opening
- Verbal response
- Best motor response
What causes sepsis?
Any infection can trigger sepsis
Where are common sites of infection at can trigger sepsis? (4 points)
- Lungs (64%)
- Abdomen (20%)
- Bloodstream (15%)
- Urinary system (14%)
What are examples of microbial factors that can cause some infections to progress to sepsis? (5 points)
Virulence factors:
- LPS
- Lipoteichoic acid
- Peptidoglycan
- Pili, fimbriae, capsule etc
Virulence contributes to pathogenicity (the ability of a microbe to cause disease)
What are examples of Host factors that can cause some infections to progress to sepsis? (6 points)
- Innate immunity
- Adaptive immunity
- Immuno-compromised (HIV/AIDS, cancer, auto immunity, organ transplant)
- Pre-existing chronic conditions (diabetes, cirrhosis, CKD)
- Age
- Genetics
Which part of the population most commonly gets sepsis?
- The ageing population
Sepsis disproportionally affects medically and immune-compromised patients. What are examples of medically conditions that can increase a patients susceptibility? (6 points)
- Cancer
- Cirrhosis
- Autoimmunity
- HIV/aids
- Organ transplantation
- Diabetes
What are common pathophysiology signs of sepsis? (4 points)
- Dysregulated, excessive systemic inflammation
- Body-wide blood clotting and ‘leaky vessels’
- One or more organs beginning to fail
- Persistent hypotension
What is acute inflammation?
- A protective immune reactions when it identifies invading microorganisms or endogenous signals from damaged cells
Acute inflammation gives rise to the cardinal signs of inflammation which are localised to the site of infection. What does this lead to? (3 points)
- Leads to the clearance of the source of injury and necrotic tissue
- Followed by tissue repair and
- Return to homeostasis
What is the process of the innate immune system response to infection? (5 points)
- Innate immune system recognises PAMP’s and DAMP’s through PRR’s and is activated
- Cells detect this signal and respond through the release of cytokines and chemokines
- Cytokines activate endothelial cells, vasodilation and vascular permeability
- Large amounts of cytokines activate acute phase proteins int he liver, platelet activation and symptoms of fever
- Activation of complement
Is resolution of inflammation an active or passive process?
- Active
- Involves several regulatory mechanisms
You get immune suppression via anti-inflammatory mediators. What are 2 examples of these?
- IL-10
- TGF-b
In sepsis, the immune response fails to eliminate the pathogen. This causes localised acute inflammation to progress to what?
- Progresses to acute systemic inflammation
Do patients with sepsis demonstrate excessive inflammation and immune suppression?
- Yes
What processes causes the excessive inflammation in people with sepsis? (3 points)
- Strong activation of innate immunity via PAMP’s and DAMP’s
- Sustained hyperinflammation
- Activation of complement system, coagulation system and vascular endothelium
Does sustained inflammation cause tissue injury?
- Yes
What causes immune suppression in people with sepsis? (4 points)
- Both innate and adaptive immunity
- Apoptosis of T cells and B cells
- Dysfunctional dendritic cells
- Delayed apoptosis of immature dysfunctional neutrophils
What are 2 treatments that should be given to patients with sepsis early?
- Early IV of antibiotics is essential to limit the spread of infection
- Fluids are given early as well
Why should dentists care about sepsis?
- Sepsis is a rare but potentially serious complication of acute dental infections
What oral conditions could be a potential source of sepsis ? (3 points)
- Abscesses
- Caries
- Fungal infections
Why do dental abscesses develop?
- Develop as a consequence of acute inflammatory response to bacterial infection
What do dental abscesses contain? (3 points)
- Immune cells, dead tissue, LIVE bacteria
Are dental abscesses highly infective?
- Yes
How would you treat a dental abscess? (2 points )
- Treated promptly by excision and drainage
- Periapical abscesses require root canal treatment or extraction
Are antibiotic effecting in treating abscesses?
- no
Can dental abscesses spread and lead to severe local and systemic consequences?
- Yes
What are the red flag signs and symptoms of spreading dental infections? (6 points)
- Temp 38
- Elevated breathing rate (>20 breaths/min)
- Elevated or reduced heart rate
- Varying degrees of facial swelling
- Trismus
- Dehydration
What is trismus?
Spasm of the jaw muscles, causing the mouth to remain tightly closed
