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Infection > Sepsis and septic shock > Flashcards

Sepsis and septic shock Flashcards

1
Q

What is the definition of sepsis?

A

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

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2
Q

What is the traditional model of sepsis?

A

SIRS -> sepsis -> severe sepsis -> septic shock

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3
Q

What is sepsis a combination of?

A

SIRS + infection

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4
Q

What is severe sepsis a combination of?

A

Sepsis + end organ damage

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5
Q

What is septic shock a combination of?

A

Severe sepsis + hypotension

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6
Q

What is a quickSOFA (qSOFA) score?

A

Abnormal mental status
RR >22/min (tachypnea)
Systolic BP <100mmHg (hypotension)

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7
Q

What does a SOFA score >2 mean?

A

Overall mortality risk 10% in general hospital population with suspected infection

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8
Q

At what SOFA score can organ dysfunction be identified as an acute change?

A

> 2

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9
Q

For each hour’s delay in administering antibiotics in septic shock, what percentage does mortality increase by?

A

7.6%

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10
Q

What are barriers the body has against sepsis?

A

Physical barrier
Innate immune system
Adaptive immune system

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11
Q

What is the origin of sepsis?

A

Breach of integrity of host barrier - physical or immunological - organism enters via bloodstream

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12
Q

Patients with sepsis have features consistent with immunosuppression, which are:

A

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

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13
Q

What are the three phases in the pathogenesis of sepsis?

A
  1. Release of bacterial toxins
  2. Release of mediators
  3. Effects of specific excessive mediators
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14
Q

What are some commonly released toxins in the first stage of the pathogenesis of sepsis?

A

Gram neg: liopolysaccharide (LPS)
Gram pos:
Microbial-associated molecular pattern (MAMP)
Superantigens

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15
Q

What are the two types of mediator roles in sepsis?

A

Pro-inflammatory mediators

Compensatory anti-inflammatory mediators

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16
Q

What do pro-inflammatory mediators do?

A

Cause inflammatory responses that characterise sepsis

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17
Q

What do compensatory anti-inflammatory mediators do?

A

Can cause immunoparalysis

18
Q

What happens when the balance between pro-inflammatory mediators and compensatory anti-inflammatory mediators shifts towards pro-inflammatory?

A

Septic shock with multi organ failure and death

19
Q

What happens when the balance between pro-inflammatory mediators and compensatory anti-inflammatory mediators shifts towards compensatory anti-inflammatory?

A

Immunoparalysis with uncontrolled infection and multi organ failure

20
Q

What are the general features of sepsis?

A 
Fever >38'C
Hypothermia <36'C
Tachycardia >90bpm
Tachyponea >20/min
Altered mental status
Hyperglycaemia >8mmol/l in absence of diabetes
21
Q

How does a fever present in sepsis?

A 
Chills
Rigors
Flushes
Cold sweats
Night sweats
22
Q

What is a FBC likely to show in sepsis?

A 
Leucocytosis
Leucopenia
Normal WCC
High CRP
High procalcitonin
23
Q

What is leucocytosis?

A

Increase in number of white cells in blood

24
Q

What is leucopenia?

A

Reduction of number of white cells in blood

25
Q

What is the blood pressure likely to be in sepsis?

A

Arterial hypotension (systolic <90mmHg)

26
Q

What is the SvO2 likely to be in sepsis?

A

> 70%

27
Q

What are other organ dysfunction signs of sepsis?

A 
Arterial hypoxaemia
Oliguria
Creatinine increase
Coagulation abnormalities
Ileus
Thrombocytopenia
Hyperbilirubinaemia
28
Q

What is the tissue perfusion like in sepsis?

A 
High lactate
Skin mottling
Reduced capillary perfusion
Non-blanching rsh of skin
Cyanosis
29
Q

What host effects can affect sepsis presentation?

A

Age
Co-morbidities
Immunosuppression
Previous surgery

30
Q

What are the SEPSIS 6?

A 
Oxygen
Blood cultures
Antibiotics
IV fluid challenge
Blood lactate
Measure urine output
31
Q

Why blood cultures for SEPSIS 6?

A

Make microbiological diagnosis

Can repeat if rise in temp

32
Q

Why blood lactate in SEPSIS 6?

A

Marker generalised hypoperfusion/severe sepsis/poor prognosis

33
Q

Why measure urine output SEPSIS 6?

A

Low urine output = marker renal dysfunction

34
Q

What is type A lactic acidosis due to?

A

Hypoperfusion

35
Q

What is type B lactic acidosis due to?

A

Mitochondrial toxins
Alcohol
Malignancy
Metabolism errors

36
Q

When should you consider HDU referral in sepsis?

A 
Low BP response to fluids
Lactate >2
Elevated creatinine
Oliguria
Liver dysfunction
37
Q

When should you consider ITU referral in sepsis?

A

Septic shock
Multi-organ failure
Sedation, intubation, ventilation

38
Q

If qSOFA above 2 what should you do?

A

Start SEPSIS 6

39
Q

What is the CURB65 score?

A

Pneumonia severity score

40
Q

What are the prognostic features in the CURB65 scoring system for pneumonia?

A 
Confusion
Raised blood urea nitrogen
Raised RR
Low BP
Age 65+
41
Q

What is a high risk CURB65 score?

A

3-5

Infection (13 decks)

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