SEPSIS, Septicaemia & SIRS

Question 1

Define;

• Infection
• Bacteraemia
• Systemic Inflammatory Responce Syndrome (SIRS)
• Sepsis
• Sever Sepsis
• Septic shock

Answer 1

Infection;

• A microbial phenomenon characterized by an inflammatory response to the microorganisms or the invasion of normally sterile tissue by those organisms

Bacteraemia;

• Presence of bacteria in blood

Systemic Inflammatory Responce Syndrome (SIRS) is 2 or more of the following;

1. Fever >38C or <36C
2. HR >90bpm
3. RR >20 (or PaCO₂<32mmHg)
4. WBC >12000/mm³ or <4000/mm³

Sepsis;

• Systemic responce to infection
• SIRS + confirmed/presumed infection!

Sever Sepsis;

• Sepsis + organ hypoperfusion

Septic shock;

• Sepsis + Persistent hypotension and perfusion abnormalities despite adequate fluid resuscitation

Question 2

Outline the pathophysiology of sepsis

Answer 2

​Insult (infection);

1. TNFa & IL1b from macrophases in responce to endotoxins
   
   • Stimulating IL6, 8 & 10 release
     
     • Fever
     • Clotting cascade
2. MASS release of pro-inflam cytokines
   
   • IL 1b, 4, 6, 8 & 10
   • TNFa
   • TGFb
   • NO (vasodilation + reflex tachycardia)

Question 3

How do you manage sepsis?

Answer 3

Sepsis 6;

1. Oxygenation & ventilation
2. Take blood cultures (2, take urine/ faeces/ CSF if suspect)
3. Give broad spectrum antibiotics
4. Give intravenous fluid challenge
5. Measure serum lactate (ABG/ blood lactate) & haemoglobin (FBC)
6. Measure accurate hourly urine output

• All cases; FBC, serum creatinine & electrolytes, blood glucose, liver biochemistry, coagulation, blood gases, ECG
• Treat underlying cause
• Treat complications eg;
  
  • Coagulapathy
  • Acute kidney injury