Session 3- sepsis & meningitis

Question 1

Six most common symptoms of sepsis?

Acronym = SEPSIS

Answer 1

Slurred speech/ confusion
Extreme shivering/ muscle pain 
Passing no urine (1 day)
Severe breathlessness
It feels like you're going to die
Skin is mottled/ discoloured

Question 2

What are the sepsis 6?

Answer 2

3 treatments, 3 investigations

• Give fluids
• Give antibiotics
• Give oxygen
• Take blood cultures
• Monitor urine output
• Take Haemoglobin and lactate

Question 3

What is the National Early Warning Score?

A score of __ could indicate sepsis?

Answer 3

NEWS is a scoring system whereby 6 physiological parameters are measured and given a score to indicate the deviance from normal. The cumulative score measures the severity of acute illness.

5+

Question 4

3 categories of WBC are 
- monocytes
- lymphocytes
- granulocytes 
What are they different granulocytes?

Answer 4

neutrophils
eosinophils
basophils

Question 5

Define sepsis and septic shock

Answer 5

Sepsis is a syndrome of life threatening organ dysfunction caused by a dysregulated host response to infection. The response perpetuates itself and the patient can deteriorate.

Sepsis can lead to septic shock which is categorised by

• Hypoperfusion
• High lactate (hypoxic tissues respire anaerobically)

Question 6

Sepsis usually occurs in response to what?

What does it present like?

Answer 6

Infection by gram negative bacteria

All the symptoms of a usual infection, plus organ failure

Question 7

What are empirical antibiotics?

Answer 7

Those given before the diagnosis is made. (Based on experience).

Question 8

Why give oxygen and fluids in sepsis?

Answer 8

Oxygen to treat hypoxic tissues and prevent an accumulation of lactate (septic shock)
Fluids to raise circulating volume and pressure to optimise tissue perfusion (prevent septic shock)

Question 9

What drugs may be given in septic shock?

Answer 9

Inotropes to increase heart contractility (cardiac output) to maintain blood pressure
Vasopressors to constrict vessels and increase blood pressure

Question 10

Poor perfusion in sepsis is due to low circulating volumes and a procoagulant state. Explain

Answer 10

Acute infection causes increased venous permeability and vasodilation which causes lower circulating volume and pressures.
Low volume compounded by reduced Left sided contractility (Starling mechanism).
Pericapillary oedema creates a larger diffusion pathway for oxygen to reach tissues.

Increased synthesis of procoagulants:
- Tissue factor
- Plasminogen activator inhibitor type 1
And reduced levels of circulating anticoagulants.
Causes microthrombi in the capillaries
(Clotting effect enhanced because the capillary diameter is reduced due to mural oedema- in the vessel wall).

Question 11

How does each pro-coagulant increase clotting?

• Tissue factor
• Plasminogen activator inhibitor type 1

Answer 11

• Tissue factor involved in conversion of prothrombin to thrombin
• Inhibits activation of plasmin (from plasminogen). Plasmin degrades fibrin clots

Question 12

Why can clotting and bleeding occur in sepsis?

Answer 12

Clotting in small vessels occurs because there are more pro-coagulants produced and cytokines (released from immune cells) initiate tissue factor dependant coagulation.

Bleeding occurs because the small clots use up many circulating anti-coagulation factors and (anti)coagulation pathways are insufficiently controlled to produce more.

Question 13

Why could a patient with sepsis be confused/ have slurred speech?

Answer 13

Reduced blood flow to brain

Sepsis = hypoperfusion and high lactate

Question 14

Effect of sepsis on temperature?

Answer 14

Usually fever due to hypothalamic response to infection

Hypothermia can occur in elderly (< 36 degrees Celsius).

Question 15

Drugs to treat meningitis infection?

Answer 15

Ceftriaxone (cephalosporin) before diagnosis

Ampicillin / Penicillin G because they bypass the blood-brain barrier