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Infections > Sepsis and septic shock > Flashcards

Sepsis and septic shock Flashcards

1
Q

How is sepsis defined?

A

Life threatening organ dysfunction caused by dysregulated host response to infection

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2
Q

How is organ dysfunction graded in sepsis?

A

SOFA score

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3
Q

What SOFA score identifies sepsis?

A

> 2 consequent to infection

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4
Q

What is septic shock?

A

Sepsis with persisting hypotension requiring vasopressors to maintain MAP of over >65mmHg with serum lactate >2mmol/l despite adequate volume resus

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5
Q

What are the criteria in qSOFA?

A

Hypotension - Systolic BP<100
Altered mental status - GCS<15
Tachypnoea - RR>22

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6
Q

What does qSOFA stand for?

A

Quick Sequential Organ Failure Assessment

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7
Q

What physical barrier does the body have against sepsis?

A

Skin
Mucosa
Epithelial lining

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8
Q

How does the innate immune system protect the body from sepsis?

A

IgA in GI tract
Dendritic cells
Macrophages

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9
Q

How does sepsis originate?

A

Breach of integrity of host barrier - physical or immunological
Organism enters the blood stream

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10
Q

What is the pathophysiology of sepsis?

A

Uncontrolled inflammatory response
Features consistent with immunosuppression - loss of delayed hypersensitivity, inability to clear infection, predisposition to nosocomial infection

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11
Q

What are the three phases in sepsis pathogenesis?

A

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

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12
Q

What are common toxins released by bacteria in sepsis?

A

Gram negative - Lipopolysaccharide
Gram positive - Microbial-associated molecular pattern
Superantigens

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13
Q

What are examples of superantigens?

A

Staphylococcal toxic shock syndrome toxin

Streptococcal exotoxins

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14
Q

What happens as a result of exotoxin release?

A

Pro-inflammatory response - small amounts of superantigens cause a large amount of mediators to be secreted

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15
Q

What are the 2 types of mediators?

A

Pro-inflammatory

Anti-inflammatory

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16
Q

What effects does excessive pro-inflammatory mediators have?

A

Promote endothelial cell - leukocyte adhesion
Release arachidonic acid metabolites
Complement activation
Vasodilation of blood vessels by Nitric Oxide
Increase coagulation by release of tissue factors and membrane coagulants
Cause hyperthermia

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17
Q

What effects does excessive anti-inflammatory mediators have?

A

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

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18
Q

What is the outcome of sepsis when pro-inflammatory mediators outbalance anti-inflammatory mediators?

A

Septic shock with multiorgan failure and death

19
Q

What is the outcome of sepsis when anti-inflammatory mediators outbalance pro-inflammatory mediators?

A

Immunoparalysis with uncontrolled infection and multiorgan failure

20
Q

What are neurological features of sepsis?

A

Altered consciousness
Confusion
Psychosis

21
Q

What are respiratory features of sepsis?

A

Tachypnoea
PaO2<70mmHg
Sats<90%

22
Q

What are liver features of sepsis?

A

Jaundice
Raised LFTs
Decrease albumin
Increased prothrombin time

23
Q

What are haematological features of sepsis?

A

Decreased platelets
Increased prothrombin time/activated prothromboplastin time
decreased CRP
Increased D-dimer

24
Q

What are cardio features of sepsis?

A

Tachycardia

Hypotension

25
Q

What are renal features of sepsis?

A

Oliguria
Anuria
Increased creatinine

26
Q

What are general features of sepsis?

A

Fever >38 - chills, rigors, flushes, cold sweats
Hypothermia in young and elderly - immunosuppressed
Tachycardia >90
Tachypnoea>20
Altered mental status
Hyperglycaemia in absence of diabetes

27
Q

What is leucocytosis?

A

WCC>12/l

28
Q

What is leucopenia?

A

WCC<4/l

29
Q

What are features of perfusion in sepsis?

A

High lactate

Skin mottling and reduced capillary fusion

30
Q

What factors of the host affect sepsis presentation?

A

Age
Co-morbidities ie COPD, diabetes, etc
Immunosuppression - HIV, drug induced, congenital
Previous surgery

31
Q

What factors of the causative organism effect sepsis presentation?

A

Gram positive or negative
Virulence factors
Bioburden

32
Q

What environmental factors effect sepsis presentation?

A

Occupation
Travel
Hospitilisation

33
Q

What is SIRS?

A

Systemic Inflammatory Response Syndrome

34
Q

What is the sepsis 6?

A 
Take blood cultures
Take blood lactate
Take urine output
Give Oxygen
Give IV antibiotics
Give IV fluids
35
Q

What is the time frame for the sepsis 6?

A

Within an hour of presenting

36
Q

Why do we take blood cultures?

A

Make a microbiological diagnosis

37
Q

How many blood cultures should be taken?

A

2

38
Q

Why do we take lactate?

A

It is a measure of generalised hypoperfusion

39
Q

Why do we take urine output?

A

Marker of renal dysfunction

40
Q

What is type A lactate a sign of?

A

Hypoperfusion

41
Q

What is type B lactate a sign of?

A

Mitochondrial toxins
Alcohol
Malignancy
Metabolism errors

42
Q

How much fluid is given in sepsis?

A

30ml/kg

43
Q

When should HDU referral be considered?

A 
Low BP responsive to fluids
Lactate>2 despite fluid resus
Elevated creatinine
Oliguria
Liver dysfunction
Bilateral infiltrates
44
Q

When should ITU be considered?

A

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

Infections (14 decks)

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