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Infection A > Session 3 Lecture 1 > Flashcards

Session 3 Lecture 1 Flashcards

1
Q

Define sepsis

A

Life threatening organ dysfunction due to dysregulated host response to infection

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2
Q

Define septic shock

A

Persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation

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3
Q

What is bacteraemia?

A

The presence of bacteria in the blood

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4
Q

What is septicaemia?

A

Outdated clinical term meaning generalised sepsis

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5
Q

What is the difference between sepsis and bacteraemia?

A

Sepsis is associated with an inflammatory response whereas bacteraemia is just the presence of bacteria in the blood.

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6
Q

What are the consequences of bacteraemia?

A

Several health consequences. Immune response to the bacteria can cause sepsis and septic shock.

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7
Q

What is the treatment for bacteraemia?

A

Antibiotics

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8
Q

How do we recognise sepsis?

A
  • Clinical assessment of patients who look sick or have EWS
  • Clinical features suggesting source
  • Check for red flags
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9
Q

What is EWS?

A

Early warning score - basic observation eg RR, HR, temp, BP

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10
Q

What are the key symptoms of sepsis? (I.e. The red flags)

A

High RR, low BP, high HR and unresponsiveness

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11
Q

If a patient has red flag sepsis, what are the next steps taken?

A
  • Immediate action required
  • Inform senior doctor for review
  • Send urgent investigations
  • Complete sepsis six bundle
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12
Q

What urgent investigations will you need to do if someone has red flag sepsis?

A
  • Full blood count, urea and electrolytes
  • EDTA bottle for PCR
  • Blood sugar
  • Liver function tests
  • CRP
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13
Q

What is the sepsis six bundle?

A

A bundle of medical therapies designed to reduce the mortality of patients with sepsis.

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14
Q

What two types of steps does the sepsis six bundle contain?

A

Three diagnostic and three therapeutic steps

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15
Q

How quickly does the sepsis six bundle needed to be delivered?

A

Aimed to be delivered within one hour of diagnosis of sepsis

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16
Q

What does the sepsis six bundle contain?

A

Oxygen, blood culture, IV antibiotics, fluid challenge,lactate and measure urine output.

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17
Q

What are the causes of sepsis?

A

Sepsis can be triggered by an infection in any part of the body.

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18
Q

What are the most common sites of infection learning to sepsis?

A

Lungs, urinary tract, abdomen and pelvis

19
Q

What types of infection are associated with sepsis?

A

Pneumonia, appendicitis, UTI, meningitis, bone infection and flu

20
Q

Who is more prone to getting sepsis?

A

Pregnant, immunosuppressed (HIV/cancer) and diabetics

21
Q

What pathogen is responsible for meningococcal meningitis?

A

Bacterium neisseria menengitidis

22
Q

How is meningococcal meningitis spread?

A

Direct contact with respiratory secretions

23
Q

Describe the structure of neisseria meningitis

A

Non motif, gram negative diplococcus

Shaped like a kidney bean and always appears in pairs

24
Q

What is a component of the the outer membrane and what effects does this have?

A

Lipopolysaccharide. This acts an endotoxins and triggers inflammation

25
Q

What effects does the polysaccharide capsule have on the neisseria meningitidis?

A

Prevents phagocytosis

Promotes adherence

26
Q

What are the two different types of inflammation?

A

Local or systemic

27
Q

What is the effect of local inflammation?

A

Stimulate inflammatory response to promote wound repair and recruit RE system

28
Q

What is the effect of systemic inflammation?

A

Stimulating growth factor, macrophages and platelets. Goal is control of infection

29
Q

What chemicals are responsible for local inflammation?

A

Cytokines, Tissue necrosis factor and interleukins

30
Q

What chemicals are responsible for systemic inflammation?

A

Cytokines released into circulation.

31
Q

What are cytokines?

A

Broad and loose category of small proteins that are important in cell signalling

32
Q

What do cytokines do?

A

Initiate production of thrombin and thus promote coagulation. Also inhibit fibrinolysis

33
Q

What does the coagulation cascade lead to?

A

Microvascular thrombosis and hence organ ischaemia, dysfunction and failure

34
Q

What is the major cause of shock and multiorgan failure?

A

Microvascular injury

35
Q

Give an example of how supportive care is used in sepsis

A

Consider referral to ITU, sepsis six and regular monitoring and reassessment.

36
Q

What does supportive care entail?

A

Involves symptom relief and physiological restoration.

37
Q

With regards to infection, what does specific treatment involve?

A

Antimicrobial or surgery

38
Q

What is the treatment for someone diagnosed with neisseria meningitis ?

A
  • Antibiotics
39
Q

What do we need to consider before giving someone with neisseria meningitis antibiotics?

A

Need to give an agent that is likely to be active against the pathogens that cause meningitis in this age group. Agent also needs to penetrate into the CSF

40
Q

What antibiotic is used to treat neisseria meningtis?

A

Ceftriaxone

41
Q

What are the life threatening complications of neisseria meningitis?

A
  • Irreversible hypotension
  • Resp failure
  • Acute kidney injury
  • Raised intercranial pressure
  • Ischaemic necrosis of digits/hand/feet
42
Q

How would you confirm the diagnosis of neisseria meningitis?

A
  • Blood culture
  • PCR of blood
  • Lumbar puncture - microscopy and culture of CSF and then PCR of CSF
43
Q

What are the different methods of preventing infection?

A

Vaccine and antibiotic prophylaxis

Infection A (18 decks)

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