Session 3-Acute Sepsis Flashcards
What is a purpuric rash?
Non-blanching small red lesions which don’t go pale when the area is pressed
What is purpuric rash a feature of?
Meningococcal infections
Define sepsis
Life-threatening organ dysfunction due to a dysregulated host response to infection
What is septic shock?
Persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation
What is bacteraemia?
Presence of bacteria in the blood
What are the Red Flags for sepsis? (3)
1) high respiratory rate
2) low blood pressure
3) unresponsive
Which basic observations are involved in the Early Warning Score (EWS)?
Respiratory rate
Heart rate
Temperature
Blood pressure
What is included in the Complete Sepsis Six Bundle?
1) oxygen
2) blood cultures
3) IV antibiotics
4) fluid challenge
5) lactate - measure of disturbed metabolism
6) measure of urine output
Which urgent investigations are conducted for a patient with suspected sepsis? (7)
1) full blood count, urea, electrolytes
2) blood sugar
3) liver function tests
4) CRP
5) coagulation studies
6) blood gases
7) other microbiology samples (CSF, urine etc)
True or false: sepsis can be caused by meningococcal meningitis
TRUE
Give an example of a bacterial pathogen causing meningococcal meningitis
Neisseria meningitidis
How is Neisseria meningitidis spread?
Direct contact with respiratory secretions
What is the endotoxin produced by Neisseria meningitidis and what does it do?
Lipopolysaccharide triggers inflammation
What feature on the surface of bacteria enhances attachment to the host?
Pilus
What does the polysaccharide capsule of bacteria do? (2)
1) Promotes adherence
2) Prevents phagocytosis
What is the local response in the inflammatory cascade when a bacterial endotoxin binds to macrophages?
Cytokines, such as tumour necrosis factors and interleukins (TNF-alpha and IL-1) stimulate inflammatory response to promote wound repair
What is the systemic response in the inflammatory cascade when a bacterial endotoxin binds to macrophages?
Cytokines are released into circulation, stimulating Growth Factor, macrophages and platelets
Complete the sentence:
In sepsis, cytokines lead to the activation of the _________ cascade. The body doesn’t manage circulation so the blood supply to vital organs (eg. ________) is _______________.
Humoral
Kidneys
Compromised
What do cytokines initiate the production of?
Thrombin and thus promote coagulation
What do cytokines inhibit?
Fibrinolysis
What does the coagulation cascade lead to?
Microvascular thrombosis and therefore organ ischaemia, dysfunction and failure.
What is the major cause of shock and multiorgan failure?
Microvascular injury
Describe the supportive care methods for treating sepsis (3)
1) early referral to ITU
2) sepsis six
3) regular monitoring and reassessment
What are the life-threatening complications associated with sepsis? (5)
1) irreversible hypotension
2) respiratory failure
3) acute kidney injury
4) raised intercranial pressure
5) ischaemic necrosis of digits/hands/feet
Which methods are used to confirm the diagnosis of sepsis? (3)
1) blood culture
2) PCR of blood
3) lumbar puncture (if safe) to see if meninges are inflamed: microscopy and culture of CSF and then PCR of CSF
What time of meningococcus is Neisseria meningitidis?
Gram-negative diplococcus (pink stained)
What are the numerous serogroups of Neisseria meningitidis based on?
Polysaccharide capsular antigen
What are the two methods of preventing sepsis?
1) vaccination
2) antibiotic prophylaxis
