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Infection > Sepsis and Septic Shock > Flashcards

Sepsis and Septic Shock Flashcards

1
Q

What is sepsis?

A

Life-threatening organ dysfunction caused by dysregulated host response to infection

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2
Q

What is septic shock?

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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3
Q

What are the body’s defences against sepsis?

A

Physical barrier
Innate immune system
Adaptive immune system

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4
Q

Physical barrier

A

Skin
Mucosa
Epithelial lining

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5
Q

Innate immune system

A

IgA in gastrointestinal tract

Dendritic cells/macrophages

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6
Q

Adaptive immune system

A

Lymphocytes

Immunoglobulins

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7
Q

Pathophysiology of sepsis

A

Uncontrolled inflammatory response
Features consistent with immunosuppression
Probable change of the sepsis syndrome over time

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8
Q

Features of immunosuppression

A

Loss of delayed hypersensitivity
Inability to clear infection
Predisposition to nosocomial infection

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9
Q

Change in sepsis 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 patient

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10
Q

What are the three phases in the pathogenesis of sepsis?

A

Release of bacterial toxins
Release of mediators
Effects of specific excessive mediators

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11
Q

Gram negative commonly released toxins

A

Lipopolysaccharide

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12
Q

Gram positive commonly released toxins

A

Microbial-associated molecular pattern

Superantigens

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13
Q

Superantigens

A

Staphylococcal toxic shock syndrome toxin (TSST)

Streptococcal exotoxins

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14
Q

Microbial-associated molecular pattern (MAMP)

A

Lipoteichoic acid

Muramyl dipeptides

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15
Q

What are the sepsis 6?

A 
Take 3, give 3
Blood cultures
Blood lactate
Measure urine output
Oxygen sats aim 94-98%
IV antibiotics
IV fluid challenge
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16
Q

When to consider HDU referral

A 
Low BP responsive to fluids
Lactate >2 despite fluid resuscitation
Elevated creatinine 
Oliguria
Liver dysfunction, Bil, PT, Plt
Bilateral infiltrates, hypoxaemia
17
Q

When to consider ITU

A

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

18
Q

General features of sepsis

A

Fever >38oC – presenting as chills, rigors, flushes, cold sweats, night sweats, etc

Hypothermia <36oC – especially in the elderly and very young children (remember the immunosuppressed)

Tachycardia >90 beats/min

Tachypnoea >20 /min

Altered mental status – especially in the elderly

Hyperglycaemia >8mmol/l in the absence of diabetes

19
Q

Inflammatory variables in sepsis

A 
Leucocytosis
Leucopenia
Normal WCC with greater than 10% immature forms
High CRP
High procalcitonin
20
Q

Tissue perfusion variables in sepsis

A

High lactate

Skin mottling and reduced capillary perfusion

21
Q

Effects of infections due to endotoxin release

A

LPS needs an LPS-binding protein to bind to macrophages

LTA do not need such proteins

22
Q

Effects of infections due to exotoxin release

A

Pro-inflammatory response

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

23
Q

Mediator role in sepsis

A

Pro-inflammatory mediators

Compensatory anti-inflammatory reaction

24
Q

Pro-inflammatory mediators

A

Causes inflammatory response that characterises sepsis

25
Q

Compensatory anti-inflammatory reaction

A

Can cause immunoparalysis

26
Q

Specific excessive mediators

A

Pro-inflammatory mediators

Anti-inflammatory mediators

27
Q

Effects of pro-inflammatory mediators

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

Effects of anti-inflammatory mediators

A

Inhibit TNF alpha
Augment acute phase reaction
Inhibit activation of coagulation system
Provide negative feedback mechanisms to pro-inflammatory mediators

29
Q

LPS

A

Lipopolysaccharide

30
Q

MAMP

A

Microbial-associated molecular pattern

31
Q

TSST

A

Toxic shock syndrome toxin

32
Q

LTA

A

Lipoteichoic acid

33
Q

TNF alpha

A

Tumour necrosis factor (part of acute inflammatory response)

34
Q

CRP

A

C-reactive protein
Blood test marker for inflammation in the body
Produced in the liver

35
Q

Procalcitonin

A

A biomarker that exhibits greater specificity than other proinflammatory markers in identifying patients with sepsis and can be used in the diagnosis of bacterial infections

Infection (16 decks)

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