Session 3-Acute Sepsis

Question 1

What is a purpuric rash?

Answer 1

Non-blanching small red lesions which don’t go pale when the area is pressed

Question 2

What is purpuric rash a feature of?

Answer 2

Meningococcal infections

Question 3

Define sepsis

Answer 3

Life-threatening organ dysfunction due to a dysregulated host response to infection

Question 4

What is septic shock?

Answer 4

Persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation

Question 5

What is bacteraemia?

Answer 5

Presence of bacteria in the blood

Question 6

What are the Red Flags for sepsis? (3)

Answer 6

1) high respiratory rate
2) low blood pressure
3) unresponsive

Question 7

Which basic observations are involved in the Early Warning Score (EWS)?

Answer 7

Respiratory rate
Heart rate
Temperature
Blood pressure

Question 8

What is included in the Complete Sepsis Six Bundle?

Answer 8

1) oxygen
2) blood cultures
3) IV antibiotics
4) fluid challenge
5) lactate - measure of disturbed metabolism
6) measure of urine output

Question 9

Which urgent investigations are conducted for a patient with suspected sepsis? (7)

Answer 9

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)

Question 10

True or false: sepsis can be caused by meningococcal meningitis

Answer 10

TRUE

Question 11

Give an example of a bacterial pathogen causing meningococcal meningitis

Answer 11

Neisseria meningitidis

Question 12

How is Neisseria meningitidis spread?

Answer 12

Direct contact with respiratory secretions

Question 13

What is the endotoxin produced by Neisseria meningitidis and what does it do?

Answer 13

Lipopolysaccharide triggers inflammation

Question 14

What feature on the surface of bacteria enhances attachment to the host?

Answer 14

Pilus

Question 15

What does the polysaccharide capsule of bacteria do? (2)

Answer 15

1) Promotes adherence

2) Prevents phagocytosis

Question 16

What is the local response in the inflammatory cascade when a bacterial endotoxin binds to macrophages?

Answer 16

Cytokines, such as tumour necrosis factors and interleukins (TNF-alpha and IL-1) stimulate inflammatory response to promote wound repair

Question 17

What is the systemic response in the inflammatory cascade when a bacterial endotoxin binds to macrophages?

Answer 17

Cytokines are released into circulation, stimulating Growth Factor, macrophages and platelets

Question 18

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 _______________.

Answer 18

Humoral
Kidneys
Compromised

Question 19

What do cytokines initiate the production of?

Answer 19

Thrombin and thus promote coagulation

Question 20

What do cytokines inhibit?

Answer 20

Fibrinolysis

Question 21

What does the coagulation cascade lead to?

Answer 21

Microvascular thrombosis and therefore organ ischaemia, dysfunction and failure.

Question 22

What is the major cause of shock and multiorgan failure?

Answer 22

Microvascular injury

Question 23

Describe the supportive care methods for treating sepsis (3)

Answer 23

1) early referral to ITU
2) sepsis six
3) regular monitoring and reassessment

Question 24

What are the life-threatening complications associated with sepsis? (5)

Answer 24

1) irreversible hypotension
2) respiratory failure
3) acute kidney injury
4) raised intercranial pressure
5) ischaemic necrosis of digits/hands/feet

Question 25

Which methods are used to confirm the diagnosis of sepsis? (3)

Answer 25

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

Question 26

What time of meningococcus is Neisseria meningitidis?

Answer 26

Gram-negative diplococcus (pink stained)

Question 27

What are the numerous serogroups of Neisseria meningitidis based on?

Answer 27

Polysaccharide capsular antigen

Question 28

What are the two methods of preventing sepsis?

Answer 28

1) vaccination

2) antibiotic prophylaxis