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Year 2- Infectious Disease > Sepsis and Septic Shock > Flashcards

Sepsis and Septic Shock Flashcards

1
Q

Sepsis?

A

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

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2
Q

SIRS?

A

Systemic inflammatory response syndrome

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3
Q

What are the features of SIRS?

A

Temperature >38 or <36
HR >90
RR >20
WBC >12,000 or <4,000

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4
Q

What is the correlation between SIRS and Sepsis?

A

Almost all people with sepsis have SIRS, but not all people with SIRS have sepsis

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5
Q

SIRS + infection =?

A

Sepsis

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6
Q

List some of the causes of SIRS without infection.

A

Pancreatitis
Burns
Trauma

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7
Q

What is the definition of sepsis?

A

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

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8
Q

What is septic shock?

A

Sepsis and persisting hypotension

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9
Q

What kind of things are looked at and monitored in patients with severe sepsis?

A

Respiration
Coagulation
LFTs
BP
Conscious level
Kidneys

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10
Q

qSOFA is used to identify patients with suspected infection who are likely to have a prolonged ICU stay or die in hospital.

What is looked at is qSOFA scoring?

A

Hypotension (systolic <100)
Altered mental state
Tachypnoea (RR>22/min)

->each one of these is worth a point and if a patient has 2 or more, there is a greater risk of a poorer outcome

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11
Q

For every hour’s delay in administering antibiotics in septic shock, the risk of mortality increases by what %?

A

7.6% every hour

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12
Q

What is the body’s physical barrier against sepsis?

A

Skin
Mucosa
Epithelial lining

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13
Q

What is the body’s innate immune system defence against sepsis?

A

IgA is GIT
Dendritic cells
Macrophages

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14
Q

What is the body’s adaptive immune system defence against sepsis?

A

Lymphocytes
Immunoglobulins

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15
Q

In order for sepsis to occur, there must be a breach in what?

A

Breach in integrity of the host barrier e.g. cut in skin, IgA issues, macrophages etc.

Microbes then enter the bloodstream to cause a septic state

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16
Q

Patients with sepsis have an uncontrolled inflammatory response.
They have features consistent with immunosuppression.
What are these features?

A

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

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17
Q

What are the three phases in the pathogenesis of sepsis?

A
  1. Release of bacterial toxins
  2. Release of mediators
  3. Effects of specific excessive mediators
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18
Q

Give an example of a commonly released toxin from gram- negative bacteria.

A

Lipopolysaccharide (LPS)

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19
Q

Give some examples of commonly released toxins from gram-positive bacteria

A

Microbial-associated molecular pattern:
-Lipoteichoic acid
-Muramyl dipeptides

Superantigens:
TSST (toxic shock syndrome)
Streptococcal exotoxins

20
Q

What does LPS need in order to bind to macrophages?

A

LPS-binding protein

->this then release mediators

21
Q

What effect does a small amount of superantigens have on the amount of mediators released?

A

Small amount of superantigens will cause a large amount of mediators to be secreted

22
Q

What are the two types of mediator that can be released in sepsis?

A

Pro-inflammatory mediators
Compensatory anti-inflammatory mediators

23
Q

What do pro-inflammatory mediators cause?

A

Inflammatory response which is characteristic of sepsis

24
Q

What can compensatory anti-inflammatory mediators cause to happen?

A

Immunoparalysis

25
Q

Give some examples of pro-inflammatory mediators.

A

TNF-alpha
Interleukin 1
interferon gamma

26
Q

Give some examples of anti-inflammatory mediators.

A

IL-10
Transforming growth factor beta

27
Q

What do the pro-inflammatory mediators promote?

A

Endothelial cell-leukocyte adhesion
Release of arachidonic acid metabolites
Complement activation
Vasodilation of blood vessels by nitrous oxide
Increase coagulation
Cause hyperthermia

28
Q

What do the anti-inflammatory mediators do?

A

Inhibit TNF alpha
Inhibit activation of coagulation system
Provide negative feedback mechanisms to pro-inflammatory mediators

29
Q

There needs to be a balance between pro-inflammatory and anti-inflammatory mediators.
What happens if there is more pro-inflammatory mediators?

A

Septic shock with multiorgan failure and death

30
Q

There needs to be a balance between pro-inflammatory and anti-inflammatory mediators.
What happens if there is more anti-inflammatory mediators?

A

Immunoparalysis with uncontrolled infection and multiorgan failure

31
Q

Which organs can be affected in sepsis?

A

Brain
Lungs
Liver
Heart
Kidneys
Blood vessels

32
Q

What are some of the general features of sepsis?

A

Fever- presenting as chills, rigors, flushes, cold sweats etc.
Tachycardia >90beats/min
Tachypnoea >20/min
Altered mental status
Hyperglycaemia

33
Q

In the very young, very old and immunosuppressed, how can sepsis present?

A

With hypothermia e.g. <36 degrees

34
Q

There can be inflammatory variability in sepsis.
Give an example.

A

Sepsis can elevate or decrease WCC

-> WCC >12,000 or <4,000

35
Q

What are some other labs findings which are suggestive of sepsis?

A

High CRP
High procalcitonin

36
Q

What are some of the tissue perfusion issues potentially seen in sepsis?

A

High lactate
Skin mottling
Reduced capillary perfusion

37
Q

What is Sepsis 6?

A

The UK Sepsis Trust developed the ‘Sepsis Six’ to be instituted within one hour by non-specialist practitioners at the frontline.

38
Q

What does the Sepsis 6 consist of?

A

Oxygen, cultures, antibiotics, fluids, lactate measurement and urine output monitoring

39
Q

RECAP- and a bit random hahaha

What is a rise in serum amylase indicative of?

A

Acute pancreatitis

40
Q

The Sepsis 6 is based on take 3 and give 3.

What do you take?

A

Blood cultures
Blood lactate
Measure urine output

41
Q

The Sepsis 6 is based on take 3 and give 3.

What do you give?

A

Oxygen
IV antibiotics
IV fluids

42
Q

For patients with sepsis, what is the aim of oxygens sats?

A

94-98%

43
Q

Why do you take blood cultures in those with sepsis?

A

To make a microbiological diagnosis

44
Q

Why do you take blood lactate in those with sepsis?

A

Marker of generalised hypoperfusion/severe sepsis/poorer prognosis

45
Q

Why do you measure urine output in those with sepsis?

A

Low urine output is a marker of renal dysfunction

46
Q

There is two types of lactate- A and B, which one is measured to give indications about hypoperfusion?

A

Type A

47
Q
A

Year 2- Infectious Disease (12 decks)

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