Sepsis and severe infections

Question 1

Describe the pathophysiology of sepsis.

Answer 1

Infection causes the release of pro-inflammatory cytokines, which recruits more immune cells to the infection site. Inflammatory mediators damage the endothelial cells lining the blood vessels, leading to increased vascular permeability. This allows fluid, proteins, and immune cells to leak into tissues, causing oedema and hypovolaemia

Nitric oxide and other vasodilators are released, causing widespread vasodilation, which leads to low blood pressure (hypotension)

Increased vascular permeability and hypotension contribute to reduced blood flow and impaired tissue perfusion. With hypoperfusion of tissues, cells undergo anaerobic metabolism, leading to lactic acidosis, which can exacerbate cellular injury and organ dysfunction

Question 2

Define sepsis.

Answer 2

A life-threatening organ dysfunction due to a dysregulated host response to infection

Question 3

Define septic shock.

Answer 3

A subset of sepsis where profound circulatory, cellular & metabolic abnormalities substantially increase mortality

Question 4

List the 3 qSOFA criteria for diagnosing sepsis.

Answer 4

Respiratory rate of at or above 22 breaths per minute

Any change in mental state

Systolic blood pressure of 100 mmHg or less

Question 5

List the 2 additional criteria for diagnosis of septic shock.

Answer 5

Persistent hypotension which requires vasopressors to maintain a mean arterial pressure (MAP) of 65 mm Hg or more

Elevated serum lactate level of 18 mg/dL or above despite adequate fluid resuscitation

Question 6

Which 6 criteria are assessed in a SOFA score?

Answer 6

Hypoxia

GCS

Hypotension

Coagulation

Bilirubin

Renal function

Question 7

List some infections which are most likely to lead to sepsis.

Answer 7

Pneumonia
Meningitis
C difficile
Pyelonephritis
Cellulitis + necrotising fasciitis
Osteomyelitis
Malaria

Question 8

What are the components of the sepsis six care bundle?

Answer 8

Give high-flow oxygen

Take blood cultures

Give empirical IV antibiotics

Measure FBC & serum lactate

Start IV fluid resuscitation

Start accurate urine output measurements

Question 9

Which resource provides detailed sepsis protocols & bundles?

Answer 9

Surviving Sepsis Campaign