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Infectious Diseases > Sepsis and Septic Shock > Flashcards

Sepsis and Septic Shock Flashcards

1
Q

What are the 4 stages of systemic infection from SIRS to septic shock

A

SIRS (Systemic Inflammatory Response Syndrome)

Sepsis

Severe sepsis

Septic shock

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2
Q

What are the criteria for SIRS?

A

Temp >38 or 90
RR >20
PaCO2 12,000 or 10% bands

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3
Q

What is Sepsis?

A

SIRS + Infection

Defined as life threatening organ dysfunction caused by dysregulated host response to infection

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4
Q

What is Severe sepsis?

A

Sepsis + End organ damage

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5
Q

What is septic shock?

A

Severe sepsis + Hypotension

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6
Q

Give some examples of conditions that would classify as SIRS but have no infective component so could not lead to sepsis

A

Pancreatitis
Burns
Trauma
Other

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7
Q

How is organ dysfunction in sepsis identified?

A

Acute change in total SOFA score >2 points consequent to the infection

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8
Q

A SOFA score >2 reflects an overall mortality risk of what?

A

Approx 10% in a general hospital population with suspected infection

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9
Q

How can septic shock be identified?

A

A clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP >65mmHg and having a serum lactate of >2mmol/l despite adequate volume resuscitation

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10
Q

What is the hospital mortality of patients with septic shock?

A

40%

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11
Q

What is measured in a Sequential Organ Failure Assessment Score?

A

Respiration
-PaO2/FiO2

Coagulation
-platelets

Liver
-Bilirubin

Cardiovascular
-MAP

CNS
-GCS

Renal

  • Creatinine
  • Urine output
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12
Q

What are the criteria for the quick SOFA (qSOFA)?

A

RR >22/min
Altered mentation
Systolic BP

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13
Q

What window would be the best for starting antimicrobial chemotherapy in someone with septic shock?

A

30 mins

Basically as soon as possible (every minute matters)

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14
Q

For each hour’s delay in administering antibiotics in septic shock, mortality increases by how much?

A

7.6%

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15
Q

What 3 broad things make up the bodies defences against sepsis?

Give examples of each

A

Physical barrier
-Skin, mucosa, epithelial lining

Innate immune system
-IgA in gastrointestinal tract, dendritic cells/ macrophages

Adaptive immune system
-Lymphocytes, Immunoglobulins

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16
Q

What is the origin of sepsis?

The basic event which causes sepsis

A

Breach of integrity of host barrier, whether physical or immunological

Organism enters the bloodstream creating a septic state

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17
Q

Patients with sepsis have features consistent with immunosuppression.

Give 3 examples

A

Loss of delayed hypersensitivity

Inability to clear infection

Predisposition to nosocomial (HAI) infection

18
Q

Give 3 ways the sepsis syndrome can probably change over time

A

Initially there is an increase in inflammatory mediators

Later, there is a shift toward an anti-inflammatory immunosuppressive phase

Depends on the health of the individual

19
Q

What are the 3 phases in the pathogenesis of sepsis?

A

Release of bacterial toxins

Release of mediators in response to infection

Effects of specific excessive mediators

20
Q

What commonly released gram negative toxins are there?

A

Lipopolysaccharide (LPS)

21
Q

What commonly relaesed gram positive toxins are there?

(2 types
-2 examples for each)

A

Microbial-associated molecular pattern (MAMP)

  • Lipoteichoic acid
  • Muramyl dipeptides

Superantigens

  • Staphylococcal toxic shock syndrome toxin (TSST)
  • Streptococcal exotoxins
22
Q

What 2 broad types of toxins can bacteria release?

A

Endotoxin

Exotoxin

23
Q

How does gram positive and gram negative endotoxin binding differ?

A

Gram negative
-LPS -> needs an LPS-binding protein to bind to macrophages

Gram positive
-LTA do not need such proteins

24
Q

Why are superantigens named as such?

A

Small amounts of superantigens will cause a large amount of mediators to be secreted: cascade effect

“cytokine storm”

25
Q

What two types of mediators can be released?

A

Pro-inflammatory
-Causes inflammatory response that characterises sepsis

Compensatory anti-inflammatory reaction
-Can cause immunoparalysis

26
Q

Which Th cell is inflammatory and which is anti-inflammatory?

A

Th1 is inflammatory

Th2 is anti-inflammatory

27
Q

Give examples of what pro-inflammatory mediators cause?

A

Promote endothelial cell leukocyte adhesion

Release of arachidonic acid metabolites

Complement activation

Vasodilatation of blood vessels by NO

Increase coagulation by release of tissue factors and membrane coagulants

Cause hyperthermia

28
Q

Give examples of what anti-inflammatory mediators cause?

A

Inhibit TNF a

Augment acute phase reaction

Inhibit activation of coagulation system

Provide negative feedback mechanisms to pro-inflammatory mediators

29
Q

Give some examples of organ dysfunction seen in sepsis

Think of all the organs that may be effected by sepsis and what this would result in

A

Altered consciousness
Confusion
Psychosis

Tachypnoea
PaO2

30
Q

Give some of the general features of sepsis?

If someone came in to hospital what signs would make you think of sepsis?

A

Fever >38
-Presenting as chills, rigors, flushes, cold sweats, night sweats etc

Hypothermia 90

Tachypnoea >20/min

Altered mental status
-Especially in the elderly

Hyperglycaemia >8mmol/l in the absence of diabetes

31
Q

What inflammatory variables will you see in sepsis?

What inflammatory blood tests will you see?

A

Leucocytosis
(WCC >12,000/ml)

Leucopenia
(WCC

32
Q

What haemodynamic variables will you see in sepsis?

What will the blood pressure and oxygen content of blood look like?

A

Arterial hypotension

(systolic 70%

33
Q

What are the signs in sepsis of organ dysfunction?

What test results would show organ damage?

A

Arterial hypoxaemia (PaO2/FiO2 1.5 or APTT >60s)

Ileus

Thrombocytopenia (

34
Q

What sign and definitive test would show decreased tissue perfusion in sepsis?

A

High Lactate

Skin mottling and reduced capillary perfusion

35
Q

What is testing lactate so important in sepsis?

A

Shows tissue perfusion which is the big worry

If lactate is staying high even with treatment this isnt good

36
Q

What antibiotics are given in sepsis?

A

Triple therapy for abdominal

  • Amoxicillin
  • Gentamicin
  • Metronidazole

Based on working diagnosis
Local guidelines

37
Q

What is involved in the management of sepsis?

A

Sepsis 6

Take 3:

  • Blood cultures
  • Blood lactate
  • Measure urine output

Give 3:

  • Oxygen aim sats 94-98%
  • IV antibiotics
  • IV fluid challenge
38
Q

What fluids should you give to a septic patient?

A

30ml/kg fluid challenge (expert opinion)

2.1L 70kg patient

39
Q

When should you consider HDU referral?

A

If evidence of severe sepsis:

  • Low BP responsive to fluids
  • Lactate >2
  • Elevated creatinine
  • Oliguria
  • Liver dysfunction, Bil, PT
  • Bilateral infiltrates, Hypoxaemia
40
Q

When should you consider ITU?

A

Septic shock

Multi-organ failure

Requires sedation, intubation and ventilation

Infectious Diseases (4 decks)

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