Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 Infection (JK) > Sepsis and septic shock > Flashcards

Sepsis and septic shock Flashcards

1
Q

Define sepsis

A

Systemic illness caused by microbial invasion of normally sterile parts of the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

4 descriptions in traditional model of sepsis

A

SIRS
sepsis - SIRS and infection
severe sepsis - sepsis and end organ damage
septic shock - severe sepsis and hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

4 SIRS criteria and how many are required to make a diagnosis?

A

temp >38 or <36
HR - >90
RR>20 or PaCO2 <32
WBC >12 000 or <4000 or >10% bands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What from the traditional model of sepsis is no longer used and why?

A

severe sepsis - no prognostic indicators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Septic shock definition

A

sepsis with refractory hypotension on vasopressors and lactate > 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List some causes of SIRS

A

pancreatitis
burns
trauma
sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

qSOFA

A

hypotension systolic bp <100mmHg
altered mental status
tachypnea RR>22/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does qSOFA tell us?

A

patients with suspected infection likely to have a prolonged ICU stay or die in hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Main management of sepsis is?

A

SEPSIS 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The main 3 body’s defences (1 barrier +2 immune systems)

A

physical barrier - skin, mucosa, epithelial lining
innate immune system - IgA in GI trac, macrophages, dendritic cells
adaptive immune system - lymphocytes, Ig

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

3 features patients with sepsis have consistent with immunosuppression?

A

loss of delayed hypersensitivity
inability to clear infection
predisposition to nosocomial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Nosocomial?

A

hospital acquired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Change in sepsis syndrome over time in terms of inflammatory and anti inflammatory

A

initial increase in inflammatory mediators

later a shift towards anti inflammatory immunosuppressive phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

3 phases of sepsis syndrome

A

release of bacterial toxins
release of mediators
effects of specific excessive mediators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Commonly released gram -ve bacterial toxins

A

LPS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Commonly released gram positive bacterial toxins

A

MAMP (LTA) or super antigens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Endotoxin - LPS

A

gram negative needs a binding protein to bind to macrophages via toll like receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Endotoxin - LTA

A

gram positive do not need a binding protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Exotoxin

A

small amounts of gram positive super antigen lead to a large amount of mediators being released - cascade effect

20
Q

What can compensatory anti inflammatory mediators cause?

A

immunoparlysis

21
Q

Example of main pro inflammatory mediator

A

TNF alpha

22
Q

Example of main anti inflammatory mediator

A

IL IRA/4/10/13

23
Q

Brief description of the role of pro inflammatory mediators

A

complement and coagulation
hyperthermia
vasodilation and endothelial cell-leucocyte adhesion

24
Q

Brief description of the role of anti inflammatory mediators

A

Inhibit TNF alpha

inhibit coagulation and provide negative feedback

25
Q

Pro inflammatory > compensatory anti inflammatory

A

septic shock with multi organ failure

26
Q

Compensatory anti inflammatory > pro inflammatory

A

immunoparalysis with uncontrolled infection and multi organ failure

27
Q

Organ dysfunction in sepsis

A

brain - confusion, psychosis, altered consciousness
blood - decrease platelets and c protein. Increase in D dimer and PT
kidneys - oliguria, anuria, increase in creatinine
Liver - jaundice, increase liver enzyme and PT, decrease bilirubin
lungs - tachypnoea, sats <90%
heart - tachycardia, hypotension

28
Q

6 general features of sepsis

A 
fever >38 degrees 
hypothermia <36 degrees 
tachycardia 
tachypnoea 
altered mental status 
hyperglycaemia
29
Q

Who is hypothermia common in sepsis in?

A

elderly and young (and immunosuppressed)

30
Q

Inflammatory variables in sepsis

A 
leucocytosis
leucopenia 
high CRP 
high procalcitonin 
normal WCC with >10% immature forms
31
Q

Haemodynamic variables in sepsis

A

arterial hypotension

SvO2 >70%

32
Q

Organ dysfunction variables in sepsis

A 
thrombocytopenia 
arterial hypoxaemia 
oliguria 
increase creatinine 
ileus
33
Q

Tissue perfusion variables in sepsis

A

high lactate

skin mottling and reduced capillary perfusion

34
Q

4 effects of the host on sepsis presentation

A

age
co morbidities
immunosuppression
previous surgery

35
Q

How the organism can affect the sepsis presentation

A

gram +ve or -ve
virulence factors
bioburden

36
Q

How the environment can affect the presentation of sepsis

A

travel
occupation
hospitalisation

37
Q

SEPSIS 6 basis

A

Take 3 - blood cultures, blood lactate, urine output

Give 3 - oxygen, IV antibiotics, IV fluid challenge

38
Q

Use of blood cultures

A

microbiological diagnosis

spike in temp? take 2 sets

39
Q

Lactate use

A

marker of generalised hypoperfusion/severe sepsis/poorer prognosis

40
Q

What is low urine output a marker of?

A

renal dysfunction

41
Q

what antibiotics to use and what to consider?

A

working diagnosis and local policy

consider allergy, CI, interactions, previous MRSA

42
Q

Lactate type A

A

hypoperfusion

43
Q

Lactate type B

A

mitochondrial toxins, alcohol, malignancy, metabolism

44
Q

Why send a patient to HDU?

A

low bp responsive to fluids
lactate >2 despite fluid resuscitation
elevated creatinine, oliguria
liver dysfunction

45
Q

Why send a patient to ITU?

A

Septic shock
multi organ failure
sedation, intubation, ventilation

46
Q

CURB 65

A 
pneumonia 
confusion 
urea 
resp rate >30 
bp low 
>65

Year 3 Infection (JK) (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions