Sepsis (Sources: Revision notes)

Question 1

What are the SIRS criteria?

Answer 1

Temperature > 38 or < 36
Heart rate > 90
Tachypnoea > 20
WCC > 12 x 10(3)/L or < 4

Question 2

Define sepsis

Answer 2

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

Question 3

What is the pathophysiology of septic shock?

Answer 3

Sepsis represents an imbalance between pro and anti-inflammatory processes
It occur when the inflammatory reposes expands beyond the localised site of infection
High concentrations of TNF-alpha and IL-1 in the circulation lead to widespread inflammation, activation of the complement system, a pro-coagulant state, endothelial dysfunction, microvascular compromise and end organ dysfunction

Question 4

What are the key elements of the surviving sepsis guidelines?

Answer 4

Resuscitation should be protocolised and quantitative
Aiming for a CVP 8-12mmHg, MAP > 65, urine output > 0.5ml/kg/hr, SVC o2 sats > 70%, normal lactate
Diagnosis - 2 or more sets of blood cultures from separate sites and culture other fluid where appropriate, ideally prior to antibiotics but not if it’s going to delay treatment by > 45 mins, imaging to identify a source as needed
Antibiotics - IV and wishing one hour of recognising sepsis, frequent review and de-escalation as able
Source -control - should be within 12 hours
Prevent additional infection - infection control policy, oral chlorhexidine, selective decontamination of the gut
Fluid - crystalloids are firstline
Vasopressors - all patients on vasopressors should have an arterial line, aim to achieve MAP 65mmHg, nomad is first choice, adrenaline is second, vasopressin may be useful
Inotropes - dobutamine if there is evidence of myocardial dysfunction
Steroids - in patients where fluid and vasopressors have not achieved adequate BP - 200mg per day hydrocortisone is suggested