Sepsis and Septic Shock

Question 1

Definition of sepsis

Answer 1

Life threatening organ dysfunction caused by dysregulated host response to infection

Question 2

Definition of septic shock and mortality rate

Answer 2

Sepsis with persisting hypotension requiring vasopressors to maintain MAP >65mmHG
AND
Having a serum lactate of >2mmol/L despite adequate volume resuscitation

Mortality of 40%

Question 3

What is SIRS

Answer 3

Systemic Inflammatory Response Syndrome

Question 4

What is qSOFA and what is its criteria

Answer 4

Quick Sepsis Related Organ Failure assesment

Used to identify patients with suspected infection who are at greater risk for a poor outcome.

It uses three criteria, assigning one point for low blood pressure (SBP≤100 mmHg), high respiratory rate (≥22 breaths per min), or altered mentation (Glasgow coma scale<15).

Question 5

General feautures of sepsis

Answer 5

• Fever (>38C, presents as chills, rigors, flushes, cold/night sweats)
• Hypothermia (36C, especially in elderly and very young children
• Tachycardia (>90bpm)
• Tachypnea >20/min
• Altered mental status (especially in elderly)
• Hyperglycaemia (8 mmol/L in non diabetics)

Question 6

What happens to Creatinine, Lactate and bilirubin in sepsis

Answer 6

They increase

Question 7

What happens to platelets during sepsis

Answer 7

They reduce (thrombocytopenia)

Question 8

What innfluences the presentation of sepsis

Answer 8

Age
Co-morbidities
Immunosuppresion
Previous surgery (splenectomy)

Question 9

55 yr M
Hx of DM, smoker and IHD
Admitted through ED with feve, nausea, vommitting + abdo pain x 4hrs

O/E
Temp - 38.3C
RR - 24/min
Pulse - 120bpm
BP - 160/85
HS - Normal
Chest - Clear 
Abdo - tenderness in epigastrium, no rebound, BS present 

Next step?

Answer 9

Sepsis 6 (Take 3 Give 3)(within 1hr of diagnosis)

1. Blood cultures
2. Blood lactate +FBC
3. Measure urine output
4. Titrate oxygen to a saturation of 94-98%%
5. IV fluid resuscitation.
6. IV antibiotics

Patient fais to improve over 6hrs. Why?
A serum amylase is taken, 1450, showing the patient has acute pancreatitis, not sepsis.

Question 10

Why take Blood cultures, serum lactate and measure urine output

Answer 10

Blood cultures - Make microbiolgical diagnosis (if spike in temp take 2 sets)
Lactate - Marker of generalised hypoperfusion/severe sepsis/poorer prognosis
Low urine output - Marker of renal dysfucntion

Question 11

When to consider ITU in sepsis

Answer 11

Septic shock
Multi-organ failure
Requires sedation, intubation and ventilation