Sepsis & septic shock

Question 1

What is the mortality from sepsis & septic shock?

Answer 1

• Sepsis - 20%
• Septic shock - 40%

Question 2

What is sepsis?

Answer 2

Life threatening organ dysfunction caused by dysregulated response to infection

Question 3

What is sepsis definition based on SOFA scoring ?

Answer 3

Increase in SOFA score by 2 points

Question 4

What is septic shock?

Answer 4

Organ dysfunction requiring vasopressor support to maintain MAP > 65mmHg and lactate > 2mmol/L

Question 5

Substances produced by micro-organisms in sepsis?

Answer 5

• ## Cytokines - Endothelial & WBC

Question 6

What kind of inflammatory processes are components of sepsis?

Answer 6

• Pro-inflammatory
• Anti-inflammatory

Question 7

Patient factors in response to sepsis?

Answer 7

• Genetics
• Age
• Chronic conditions
• Medications

Question 8

What are the pathogenic factors in response to sepsis?

Answer 8

• Load
• Virulence factor

Question 9

Meningococcal & staphylococcal presentation ?

Answer 9

Both have a typical clinical presentation

Question 10

Components of the pro-inflammatory pathway ?

Answer 10

• Organ damage
• Multi-organ dysfunction
• Organ failure

Question 11

Endothelium activation in sepsis leads to the following?

Answer 11

• Expression of adhesive molecules, WBC adhesion & activation of neutrophils
• Expression of tissue factors leading to pro-inflammatory effects
• Expression of NO leading to vasodilation
• Increased capillary permeability

Question 12

Macrovascular changes in sepsis?

Answer 12

• Hypotension
• Loss of intravascular volume

Question 13

What is Noradrenaline?

Answer 13

Potent alpha-1 agonist

Question 14

Microvascular changes in sepsis?

Answer 14

• Micro-thrombi
• Impaired oxygen exchange and delivery
• DIC
• Thrombo-embolic complications

Question 15

Cytopathic hypoxia?

Answer 15

Oxygen utilization is impaired at a mitochondrial level

Question 16

The pro-inflammatory & anti-inflmmatory pathways?

Answer 16

See image attached

Question 17

Hormones involved in stress response?

Answer 17

• Vasopressin
• Cortisol

Question 18

Drugs used in refractory hypotension?

Answer 18

• Vasopressin
• Hydrocortisone

Question 19

What is SOFA?

Answer 19

Sequential organ failure assessment

Question 20

What organs can be affected in sepsis and how?

Answer 20

• Kidney - AKI
• Lungs - Respiratory failure
• CNS - Confusion
• CVS - Hypotension
• GI - Feed intolerance
• Bone marrow - Suppression
• Liver - Dysfunction , coagulation

Question 21

Traditional biomarkers used in diagnosis of sepsis?

Answer 21

• WCC
• CRP
• Procalcitonin

Question 22

What is the peak time for CRP?

Answer 22

Usually 3 days after primary insult

Question 23

What is lactate?

Answer 23

• Marker of anaerobic metabolism
• Marker for organ damage
• Greater than 2mmol/L is diagnostic for sepsis

Question 24

Sepsis 6 within 1 hour? Take 3 and give 3 ?

Answer 24

Give:
- Oxygen
- Antibiotics
- IV fluids

Take:
- Lactate
- Culture
- Urine

Question 25

Fluid resuscitation in septic shock?

Answer 25

30ml/kg

Question 26

Steps in managing sepsis within the 1st hour?

Answer 26

• Measure lactate
• Obtain blood culture
• Broad spectrum antibiotics
• Fluid resuscitation
• Vasopressor
• re-take lactate

Question 27

What are the 3 pillars of sepsis management?

Answer 27

• Fluid resuscitation
• Antibiotics
• Source control

Question 28

Gram -ve organisms?

Answer 28

• Pseudomonas
• Stenotrophomonas
• Acinetobacter