Sepsis and septic shock

Question 1

What is sepsis?

Answer 1

Life threatening organ dysfunction caused by dysregulated host response to infection
SIRS and infection

Question 2

What is septic shock?

Answer 2

Clinical construct on sepsis with persisting hypotension and serum lactate >2, despite adequate fluids

Question 3

What are the criteria for SIRS?

Answer 3

<36 or >38 degrees
HR >90
RR >20
WBCs <4000 or >12,000

Question 4

What is severe sepsis?

Answer 4

Sepsis and end orgs damage

Question 5

What is the change in bloods over time in sepsis?

Answer 5

Initial increase in inflammatory mediators

Later shift toward anti-inflammatory immunosuppressive phase

Question 6

What are the 3 pathophysiological stages of sepsis?

Answer 6

Release of bacterial toxins
Release of mediators in response to infection
Effects of mediators

Question 7

What are the common toxins released in sepsis?

Answer 7

Lipopolysaccharide
MAMP
TSST

Question 8

What are the mediators released in response to infection?

Answer 8

Endotoxins (antiinflammatory mediators)

Exotoxins (proinflammaory mediators)

Question 9

What is specific about endotoxins?

Answer 9

Some require proteins to bind

Question 10

What is specific about exotoxins?

Answer 10

Small amounts of super antigens will cause large amounts of exotoxin mediators to be released

Question 11

What are some of the effects of pro inflammatory mediators?

Answer 11

Promote endothelial cell leukocyte adhesion
Complement activation
Vasodilation

Question 12

What are some of the effects pf anti-inflammatory mediators?

Answer 12

Inhibit activation of coagulation system

Negative feedback for pro inflammatory mediators

Question 13

What are some of the general features of sepsis?

Answer 13

Fever >38- chills, riggers, flushes, cold sweat, night sweats
Hypothermia <36, esp in young and old
HR >90
RR >20
Hyperglycaemia >8
Altered mental status

Question 14

What are the inflammatory features os sepsis?

Answer 14

WCC <4000 or >12000
High CRP
High procalcitonin

Question 15

What are the haemodynamic variables in sepsis?

Answer 15

Hypotension

SvO2 >70%

Question 16

What can organ dysfunction in sepsis cause?

Answer 16

Arterial hyperaemia
Oliguria
High creatinine
Coagulation abnormalities
Thrombocytopenia 
Hyperbilirubinaemia 
Ileus

Question 17

What host factors impact on presentation of sepsis?

Answer 17

Age
Co-morbidities
Immunosuppression
Previous surgery e.g. splenectomy

Question 18

What organism factors impact on presentation of sepsis?

Answer 18

Gram + vs gram -
Virulence factors
Bioburden

Question 19

What is the management of sepsis?

Answer 19

The sepsis 6- take 3, give 3

HDU/ITU referral in some circumstances

Question 20

What is the sepsis 6?

Answer 20

Take 3- blood cultures, blood lactate, urine output

Give 3- O2, IV antibiotics, IV fluids

Question 21

What should an HDU referral be made in sepsis?

Answer 21

Low BP
Lactate >2 despite fluids
High creatinine
Oliguria
Liver dysfunction
Bilateral infiltrates
Hypoxaemia

Question 22

When should an ITU referral be made in sepsis?

Answer 22

Septic shock

Multi-organ failure

Question 23

What is the treatment of septic shock?

Answer 23

Sepsis 6

Sedation, intubation and ventilation