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Infection > Sepsis and Septic Shock > Flashcards

Sepsis and Septic Shock Flashcards

1
Q

Sepsis-3 definition of Sepsis

A

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

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2
Q

Sepsis-3 definition of Septic shock

A 
Sepsis with
- Persistent hypotension
requiring vasopressors to maintain MAP>65mmHg
- Serum lactate > 2 mmol/L
despite adequate volume resuscitation
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3
Q

Host body defence

A
  • Physical barrier: skin, mucosa, epithelial lining
  • Innate immune system: IgA in GI, dendritic cells and macrophages
  • Adaptive immune system - lymphocytes, immunoglobulins
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4
Q

Origin of sepsis

A

Breach of integrity of host barrier (physical or immunological)
Organisms enter bloodstream creating septic state

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5
Q

Three phases of sepsis development

A
  1. Bacterial toxin release
  2. Mediator release
  3. Effects of specific excessive mediators
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6
Q

Bacterial toxin release

A
  • Bacterial invasion into body tissues
  • May/may not be neutralised/cleared by immune system
  • Gram -ve LPS
  • Gram +ve LTA/MAMP
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7
Q

Endotoxin mediator release and mechanism

A

ANTI-INFLAMMATORY (Th2)

  • Gram -ve toxin (LPS) binds to LPS binding protein which binds to macrophage which releases mediators
  • Gram +ve toxin (LTA) binds directly to macrophages which releases mediators
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8
Q

Exotoxin mediator release and mechanism

A

PRO-INFLAMMATORY (Th1)

  • Gram +ve releases superantigens (TSST/SPE) which binds to T-lymphocyte
  • T-lymphocytes activate macrophage and endothelial cells
  • Macrophages release IL-1 and TNF-alpha
  • Endothelial cells release NO
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9
Q

Th1 mediator role on sepsis

A

Pro-inflammatory

  • TNF-alpha
  • Interleukin-1 interferon gamma (INF-g)
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10
Q

Th2 mediator role on sepsis

A

Anti-inflammatory

  • Interleukin-10
  • IL-1Ra
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11
Q

Pro-inflammatory (TNF-a, INF-g) effects

A

SEPTIC SHOCK

  • Endothelial cell-leukocyte adhesion
  • Release arachidonic acid metabolites
  • Complement activation
  • Vasodilatation by NO
  • Increase coagulation (release of tissue factors and membrane coagulants)
  • Hyperthermia (TNF-a)
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12
Q

Anti-Inflammatory effects

A

IMMUNOPARALYSIS

  • Inhibit TNF-a
  • Augment acute phase reaction
  • Inhibit coagulation system activation
  • -ve feedback to pro-inflammatory mediators
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13
Q

Clinical features: Host factors

A
  • Age
  • Co-morbidities
  • Immunosuppression (acquired, drug-induced, congenital)
  • Previous splenectomy
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14
Q

Clinical features: Organism factors

A
  • Gram +ve or -ve
  • Virulence factors: MRSA, toxin secretion, ESBL, KPC
  • Bioburden
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15
Q

Clinical features: Environmental factors

A
  • Occupation
  • Travel
  • Hospitalisation
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16
Q

General clinical features of sepsis

A
  • Fever >38: chills, riggers, flushes, cold/night sweats
  • Hypothermia <36
  • Tachycardia >90
  • Tachypnoea >20
  • Altered mental status
  • Hyperglycaemia >8mmol/L
17
Q

Inflammatory variables of sepsis

A
  • Leucocytosis: WCC>12,000/ml
  • Leucopenia: WCC<4,000
  • Normal WCC with >10% immature forms
  • High CRP
  • High procalcitonin
18
Q

Haemodynamic variables of sepsis

A
  • Arterial hypotension
    <90 systolic
    <70 MAP
  • SvO2 >70&
19
Q

Organ dysfunction of sepsis

A
  • Arterial hypoxaemia (PaO2/FiO2 <50mmHg)
  • Oliguria (<0.5/kg/h)
  • High creatinine
  • Reduced coagulation (Pt>1.5, APTT>60s)
  • Ileus
  • Thrombocytopenia (<150,000/ml)
  • Hyperbilirubinaemia
20
Q

Tissue perfusion variables of sepsis

A
  • High lactate
  • Skin mottling
  • Reduced capillary perfusion
21
Q

qSOFA

A

Score more than or the same as 2

  1. Hypotension <100mmHg
  2. Altered mental status
  3. Tachypnoea >22
22
Q

Sepsis-6 Management

A

Take 3

  • Blood cultures
  • Blood lactate
  • Measure urine output

Give 3

  • Oxygen aim sats 94-98% perfusion
  • IV antibiotics
  • IV fluid challenge (30ml/kg)
23
Q

HDU referral

A
  • Low BP
  • Lactate
    ^despite fluid resus
  • Elevated creatinine
  • Oliguria
  • Liver dysfunction
  • Bilateral infiltrates, hypoxaemia
24
Q

ICU referral

A

qSOFA > or same as 2

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

Infection (13 decks)

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