Sepsis and Systemic Inflammatory Response Syndrome (SIRS)

Question 1

What features need to be present in order to diagnose SIRS. (4)

Answer 1

Two or more of the following:
Temp >38 or 90BPM.
RR >20 or PCO2 12 or 10% immature (band) forms.

Question 2

What is sepsis. (2)

Answer 2

SIRS occurring in the presence of infection.

Infection with any organism can cause acute vasodilation from inflammatory cytokines.

Question 3

What is severe sepsis.

Answer 3

Sepsis with evidence of organ hypoperfusion.

Question 4

What are some examples of hypoperfusion symptoms. (4)

Answer 4

Hypoxaemia.
Oliguria.
Lactic acidosis.
Altered cerebral function.

Question 5

What is septic shock.

Answer 5

Severe sepsis with hypotension despite adequate fluid resuscitation, or the requirement for vasopressors/inotropes to maintain blood pressure.

Question 6

What is septicaemia.

Answer 6

It is used to denote the presence of multiplying bacteria in the circulation. (it has been replaced with sepsis/SIRS).

Question 7

What organism can cause sudden and severe shock without signs of infection (fever, raised WCC).

Answer 7

Gram negative bacteria.

Question 8

What is the classic state of a patient with sepsis. (2)

Answer 8

Warm and vasodilated.

Question 9

What are some causes of sepsis. (4)

Answer 9

Viral disease.
Bacterial disease.
Fungal disease.
Parasitic disease.

Question 10

What are the clinical features of severe sepsis. (3)

Answer 10

The presence of sepsis (either a positive blood culture or clinical features of fever, tachypnoea, tachycardia, suspected infection).
Complicated by organ dysfunction, hypotension or hypoperfusion.
Manifested by low blood pressure, oliguria, hypoxia, acute confusion and lactic acidosis.

Question 11

What is the mortality rate in severe sepsis.

Answer 11

As high as 50%.

Question 12

What are some common causes of sepsis in a previously healthy individual. (7)

Answer 12

Staphylococcus aureaus. 
E.coli. 
Streptococcus pneumoniae. 
Enterococcus faecalis. 
Bacteroides fragilis. 
Neisseria gonorrhoeae. 
Anaerobes.

Question 13

What are some vulnerable hospitalised groups of people vulnerable to developing sepsis. (5)

Answer 13

Urinary catheter. 
IV catheter. 
Post surgical wound infection or deep tissue infection. 
Burns patients. 
Immunocompromised patients.

Question 14

What are the clinical features of meningococcal infection causing meningitis, septicaemia or both. (10)

Answer 14

Headache. 
Fever. 
Neck stiffness. 
Vomiting. 
Diminished consciousness. 
Focal neurological signs. 
Fever. 
Myalgia. 
Hypotension. 
Petechial or haemorrhagic rash.