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Infections > sepsis and septic shock > Flashcards

sepsis and septic shock Flashcards

1
Q

What is sepsis

A

An illness which is caused by an invasion of microbes onto normally sterile parts of the body e.g lungs and brain

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2
Q

What does SIRS stand for

A

systemic inflammatory response syndrome

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3
Q

What are the signs for suspicion of SIRS

A

temp >38 or <36
HR >90
RR>20

PaCO2<32
WBC>12000 or <4000

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4
Q

What do you need to have sepsis

A

SIRS and an infection

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5
Q

What do you need to have severe sepsis

A

sepsis and end organ damage

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6
Q

What do you need to have septic shock

A

severe sepsis with hypotension

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7
Q

What is the definition of sepsis

A

organ dysfunction caused by malfunction of hosts immune response to an infection

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8
Q

What is organ dysfunction classified as on SOFA score

A

acute change in SOFA score of more than 2 since the infection began

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9
Q

What is the definition of septic shock

A

Sepsis with persisting hypotension which requires vasopressors to maintain the MAP over 65mmHg and having a serum lactate of more than 2 mmol/l even when having adequate volume resuscitation

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10
Q

What is the qSOFA values

A

hypotension - systolic less than 100mmHg
Altered mental status
tachypnoea
resp rate higher than 22/min

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11
Q

What score in the Qsofa suggest poor outcomes

A

more than 2

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12
Q

What is the effect of delaying antibiotic treatment in septic shock

A

Mortality increases

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13
Q

What is the bodies defence against sepsis

A

Physical barrier - skin, mucosa and epithelial lining
Innate immune system - IgA in GI, dendritic cells and macrophages
Adaptive immune system - lymphocytes and immunolobulin

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14
Q

How does sepsis occur

A

The organism needs to break through the skin and get into the blood stream

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15
Q

Describe the pathogenesis of sepsis

A

Release of bacterial toxins which causes antibodies to respond with mediators that will cause the effect on the organs

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16
Q

What toxins are released by gram negatives in sepsis

A

LPS - lipopolysaccharide

17
Q

What toxins do gram positives release in sepsis

A

Microbial associated molecular pattern - Lipoteichoic acid and muramyl dipeptides

Super antigens - TSST (staphylococcal toxic shock syndrome toxin) and streptococcal exotoxins

18
Q

How do the mediators work in sepsis

A

Pro-inflammatory mediators are released which cause inflammation characteristic of sepsis

Then anti-inflammatories for compensation are released which cause immunoparalysis

19
Q

What can sepsis present with

A

delerium
tachypnoea
jaundice and high liver enzymes
kidney issues - oliguria and anuria
raised serum creatinine due to urine issues

20
Q

What is a high D dimer suggestive of

A

Pulmonary embolism but is raised in any proinflammatory reactions in the body

21
Q

What are the standard features of sepsis

A

Fever more than 38
hypothermia less than 36
tachycardia more than 90bpm
tachypnoea more than 20/min
altered mental status
hyperglycaemia over 8mmol/l

22
Q

How does the fever in sepsis present

A

chills, rigors, flushes, cold sweats, night sweats

23
Q

Why is hyperglycaemia caused by sepsis

A

Body breaks down lipids into glucose for energy to fight infections

24
Q

Why is lactate important in sepsis

A

It is caused by anaerobic metabolism so it means that the cells have low oxygen

25
Q

What is the difference between gram positive / gram negative sepsis

A

gram positives affect above the diaphragm and gram negatives usually affect lower than the diaphragm

26
Q

What is the sepsis 6

A

Take 3, give 3

Take blood cultures, blood lactate and measure urine outpute

Give oxygen (aim for sats above 94%), IV antiviotics and IV fluids

27
Q

What rate should iv fluids be given

A

30ml/kg

28
Q

What is used to identify mortality rate of patient with pneumonia and describe the values

A

CURB65
C - confusion
U - over 7 mmol/l
R - resp rate more than 30/min
B - low blood pressure systolic less than 90 and diastolic less than 60
65 - age

0-1 low risk
2 - intermeddiate risk
3-5 - high risk

29
Q

What is the treatment for low severity sepsis

A

Amoxicillin 500 mg oral

30
Q

What is the treatment of moderate severity sepsis

A

amoxiliin 500 mg plus clarithromycin 500mg (oral)

31
Q

What is the treatment for severe sepsis

A

co amoxiclav 1.2g IV plus clarithromycin 500mg IV

32
Q

What is the alternative to amoxicillin in low and moderate severity sepsis

A

doxycycline - 200mg loading dose followed by 100 mg orally

Infections (13 decks)

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