Sepsis and Septic Shock

Question 1

define sepsis?

Answer 1

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

Question 2

what characterises the systemic inflammatory response?

Answer 2

temp >38c or <36c,
HR >90,
RR >20 or PaCO2 <32,
WBCs >12,000 or <4000

Question 3

what is severe sepsis?

Answer 3

sepsis + end organ damage

Question 4

What is septic shock?

Answer 4

sever sepsis + hypotension

Question 5

what does qSOFA stand for?

Answer 5

quick Sepsis Related Organ Failure Assessment

Question 6

what does qSOFA assess?

Answer 6

hypotension (<100mmHg),
altered mental status,
tachypnoea (RR >22/min`)

Question 7

what are the 3 phases in the pathogenesis of sepsis?

Answer 7

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

Question 8

general features of sepsis?

Answer 8

fever >38c, 
rigors, 
cold sweats, 
night sweats,
or hypothermia,
tachycardia,
tachypnoea, 
altered mental status,
hyperglycaemia (>8mmol/l)

Question 9

Inflammatory variables in sepsis?

Answer 9

leucocytosis or
leucopenia,
high CRP,
high procalcitonin

Question 10

haemodynamic variables in sepsis?

Answer 10

arterial hypotension,

SvO2 >70%

Question 11

Organ dysfunction variables in sepsis?

Answer 11

arterial hypoxaemia, 
oliguria, 
creatinine,
coagulation abnormalities, 
ileus,
thrombocytopenia, 
hyperbilirubinaemia

Question 12

tissue perfusion variables in sepsis?

Answer 12

high lactate,
skin mottling,
reduced capillary perfusion

Question 13

what can change the presentation of sepsis?

Answer 13

age, 
co-morbidites, 
immunosuppression, 
previous surgery eg splenectomy,
gram +ve or gram _ve,
virulence factors, 
bioburden

Question 14

what is leucocytosis?

Answer 14

WCC >12,000/ml

Question 15

what is leucopenia?

Answer 15

WCC <4000/ml

Question 16

Define thrombocytopenia

Answer 16

platlet count <150,000/ml

Question 17

Sepsis 6, take 3 ? and give 3 ?

Answer 17

take 3- blood cultures, blood lactate, urine output measurement
Give 3- oxygen, IV antibiotics, IV fluids

Question 18

Sepsis 6, 2As, 2Bs, 2Cs

Answer 18

A- Air enriched with O2, 
    Antibiotics after blood culture
B- Blood culture
     Blood gas with lactate
C- crystalloid bolus
     Catheter

Question 19

difference between lactate type A and B

Answer 19

A= hypoperfusion 
B= mitochondrial toxins, alcohol, malignancy, metabolism errors

Question 20

volume of IV fluids required for sepsis

Answer 20

30ml/kg

Question 21

when to consider a sepsis patient for HDU?

Answer 21

low BP after fluids,
lactate >2 after fluids,
elevated creatinine, 
oliguria, 
liver dysfunction

Question 22

when to consider ICU in sepsis patient?

Answer 22

septic shock,
multi-organ failure,
require sedation, intubation and ventilation