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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
Give some examples of pro-inflammatory mediators.
TNF-alpha Interleukin 1 interferon gamma
26
Give some examples of anti-inflammatory mediators.
IL-10 Transforming growth factor beta
27
What do the pro-inflammatory mediators promote?
Endothelial cell-leukocyte adhesion Release of arachidonic acid metabolites Complement activation Vasodilation of blood vessels by nitrous oxide Increase coagulation Cause hyperthermia
28
What do the anti-inflammatory mediators do?
Inhibit TNF alpha Inhibit activation of coagulation system Provide negative feedback mechanisms to pro-inflammatory mediators
29
There needs to be a balance between pro-inflammatory and anti-inflammatory mediators. What happens if there is more pro-inflammatory mediators?
Septic shock with multiorgan failure and death
30
There needs to be a balance between pro-inflammatory and anti-inflammatory mediators. What happens if there is more anti-inflammatory mediators?
Immunoparalysis with uncontrolled infection and multiorgan failure
31
Which organs can be affected in sepsis?
Brain Lungs Liver Heart Kidneys Blood vessels
32
What are some of the general features of sepsis?
Fever- presenting as chills, rigors, flushes, cold sweats etc. Tachycardia >90beats/min Tachypnoea >20/min Altered mental status Hyperglycaemia
33
In the very young, very old and immunosuppressed, how can sepsis present?
With hypothermia e.g. <36 degrees
34
There can be inflammatory variability in sepsis. Give an example.
Sepsis can elevate or decrease WCC -> WCC >12,000 or <4,000
35
What are some other labs findings which are suggestive of sepsis?
High CRP High procalcitonin
36
What are some of the tissue perfusion issues potentially seen in sepsis?
High lactate Skin mottling Reduced capillary perfusion
37
What is Sepsis 6?
The UK Sepsis Trust developed the 'Sepsis Six' to be instituted within one hour by non-specialist practitioners at the frontline.
38
What does the Sepsis 6 consist of?
Oxygen, cultures, antibiotics, fluids, lactate measurement and urine output monitoring
39
RECAP- and a bit random hahaha What is a rise in serum amylase indicative of?
Acute pancreatitis
40
The Sepsis 6 is based on take 3 and give 3. What do you take?
Blood cultures Blood lactate Measure urine output
41
The Sepsis 6 is based on take 3 and give 3. What do you give?
Oxygen IV antibiotics IV fluids
42
For patients with sepsis, what is the aim of oxygens sats?
94-98%
43
Why do you take blood cultures in those with sepsis?
To make a microbiological diagnosis
44
Why do you take blood lactate in those with sepsis?
Marker of generalised hypoperfusion/severe sepsis/poorer prognosis
45
Why do you measure urine output in those with sepsis?
Low urine output is a marker of renal dysfunction
46
There is two types of lactate- A and B, which one is measured to give indications about hypoperfusion?
Type A
47

Year 2- Infectious Disease (12 decks)

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