sepsis + septic shock

Question 1

traditional model of sepsis

Answer 1

SIRS
sepsis (SIRS + infection)
severe sepsis (sepsis and end organ damage)
septic shock (severe sepsis + hypotension)

Question 2

definition of sepsis

Answer 2

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

Question 3

how can organ dysfunction be identified

Answer 3

acute change in total SOFA score >2 points consequent to infection

Question 4

septic shock

Answer 4

• persisting hypotension requiring vasopressors to maintain MAP>65mmHg
• serum lactate >2mmol/l

Question 5

SOFA score

Answer 5

sequential (sepsis related) organ failure assessment

Question 6

qSOFA

Answer 6

score of 2+ suggests greater risk poor outcome

hypotension - systolic BP <100mmHg

altered mental status

tachypnea - RR >22/min

Question 7

3 phases in pathogenesis of sepsis

Answer 7

release of bacterial toxins
release of mediators
effects of specific excessive mediators

Question 8

mediator role in sepsis (Th1 vs Th2)

Answer 8

Th1 response: pro-inflammatory mediators - causes inflammatory response that characterises sepsis

Th2 response - compensatory anti-inflamm reaction: can cause immunoparalysis

Question 9

what do pro-inflamm mediators do

Answer 9

promote endothelial cell-leukocyte adhesion 
release arachindonic acid metabolites 
complement activation 
vasodilation of blood vessels
increase coagulation 
cause hyperthermia

Question 10

what do anti-inflam mediators do

Answer 10

inhibit TNF-alpha
augment acute phase reaction
inhibit activation of coagulation system
provide negative feedback mechanism to pro-inflamm mediators

Question 11

balance between anti-inflamm and pro-inflamm immune responses

Answer 11

more pro-inflamm: septic shock with multiorgan failure and death

more anti-inflamm: immunoparalysis with uncontrolled infection and multiorgan failure

want 2 to be balanced

Question 12

what do clinical features of sepsis depend on

Answer 12

host
organism
environment

Question 13

sepsis 6

Answer 13

take 3, give 3

blood cultures
blood lactate
measure urine output

oxygen (aim sats 94-98%)
IV antib
IV fluid

Question 14

lactate

Answer 14

type A: hypoperfusion

type B: mitochondrial toxins, alcohol, malignancy, metabolism errors

Question 15

amber flag criteria

Answer 15

• concern mental status
• deteriorating functional ability
• immunosuppresion
• trauma/surgery last 6wks
• RR 21-24
• systolic BP 91-100
• HR 91-130
• new dysrythmia
• temp <36
• clinical signs skin, wound infection
• no urine last 12-18hrs

Question 16

reg flag criteria

Answer 16

• respond only voice/pain or unresponsive
• acutely confused
• systolic BP ≤90
• HR >130
• RR ≥ 25
• need O2 to maintain sats ≥92%
• non-blanching rash, mottled, cyanotic
• UO < 0.5ml/kg/hr for 18hrs
• lactate ≥2
• recent chemo

Question 17

sepsis 6

Answer 17

give oxygen
give broad spectrum antib
give IV fluid challenge

take blood cultures
measure serum lactate
measure urine output