Session 3 Lecture 1

Question 1

Define sepsis

Answer 1

Life threatening organ dysfunction due to dysregulated host response to infection

Question 2

Define septic shock

Answer 2

Persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation

Question 3

What is bacteraemia?

Answer 3

The presence of bacteria in the blood

Question 4

What is septicaemia?

Answer 4

Outdated clinical term meaning generalised sepsis

Question 5

What is the difference between sepsis and bacteraemia?

Answer 5

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

Question 6

What are the consequences of bacteraemia?

Answer 6

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

Question 7

What is the treatment for bacteraemia?

Answer 7

Antibiotics

Question 8

How do we recognise sepsis?

Answer 8

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

Question 9

What is EWS?

Answer 9

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

Question 10

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

Answer 10

High RR, low BP, high HR and unresponsiveness

Question 11

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

Answer 11

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

Question 12

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

Answer 12

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

Question 13

What is the sepsis six bundle?

Answer 13

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

Question 14

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

Answer 14

Three diagnostic and three therapeutic steps

Question 15

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

Answer 15

Aimed to be delivered within one hour of diagnosis of sepsis

Question 16

What does the sepsis six bundle contain?

Answer 16

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

Question 17

What are the causes of sepsis?

Answer 17

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

Question 18

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

Answer 18

Lungs, urinary tract, abdomen and pelvis

Question 19

What types of infection are associated with sepsis?

Answer 19

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

Question 20

Who is more prone to getting sepsis?

Answer 20

Pregnant, immunosuppressed (HIV/cancer) and diabetics

Question 21

What pathogen is responsible for meningococcal meningitis?

Answer 21

Bacterium neisseria menengitidis

Question 22

How is meningococcal meningitis spread?

Answer 22

Direct contact with respiratory secretions

Question 23

Describe the structure of neisseria meningitis

Answer 23

Non motif, gram negative diplococcus

Shaped like a kidney bean and always appears in pairs

Question 24

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

Answer 24

Lipopolysaccharide. This acts an endotoxins and triggers inflammation

Question 25

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

Answer 25

Prevents phagocytosis | Promotes adherence

Question 26

What are the two different types of inflammation?

Answer 26

Local or systemic

Question 27

What is the effect of local inflammation?

Answer 27

Stimulate inflammatory response to promote wound repair and recruit RE system

Question 28

What is the effect of systemic inflammation?

Answer 28

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

Question 29

What chemicals are responsible for local inflammation?

Answer 29

Cytokines, Tissue necrosis factor and interleukins

Question 30

What chemicals are responsible for systemic inflammation?

Answer 30

Cytokines released into circulation.

Question 31

What are cytokines?

Answer 31

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

Question 32

What do cytokines do?

Answer 32

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

Question 33

What does the coagulation cascade lead to?

Answer 33

Microvascular thrombosis and hence organ ischaemia, dysfunction and failure

Question 34

What is the major cause of shock and multiorgan failure?

Answer 34

Microvascular injury

Question 35

Give an example of how supportive care is used in sepsis

Answer 35

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

Question 36

What does supportive care entail?

Answer 36

Involves symptom relief and physiological restoration.

Question 37

With regards to infection, what does specific treatment involve?

Answer 37

Antimicrobial or surgery

Question 38

What is the treatment for someone diagnosed with neisseria meningitis ?

Answer 38

- Antibiotics

Question 39

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

Answer 39

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

Question 40

What antibiotic is used to treat neisseria meningtis?

Answer 40

Ceftriaxone

Question 41

What are the life threatening complications of neisseria meningitis?

Answer 41

- Irreversible hypotension - Resp failure - Acute kidney injury - Raised intercranial pressure - Ischaemic necrosis of digits/hand/feet

Question 42

How would you confirm the diagnosis of neisseria meningitis?

Answer 42

- Blood culture - PCR of blood - Lumbar puncture - microscopy and culture of CSF and then PCR of CSF

Question 43

What are the different methods of preventing infection?

Answer 43

Vaccine and antibiotic prophylaxis