Severe infection & sepsis

Question 1

Define infection

Answer 1

Invasion & multiplication of pathogenic microbes

Question 2

Define SIRS

Answer 2

systemic inflammatory response syndrome
>1 of:
- temperature 38°C
- heart rate >90/min
- respiratory rate >20/min or pCO2 12x109/dl or >10% immature WBCs

Question 3

Define sepsis

Answer 3

systemic inflammatory response to infection (SIRS + known or suspected infection)

Question 4

Define severe sepsis

Answer 4

sepsis + organ dysfunction (including septic shock)

Question 5

Define septic shock

Answer 5

sepsis + hypotension (SBP

Question 6

What is the sepsis 6?

Answer 6

Within 1 hour of suspecting severe sepsis → Sepsis Six Care Bundle:

1. Give high-flow oxygen
2. Take blood cultures – identify what’s in the blood to get right ABX
3. Give empirical IV antibiotics – don’t know what best ABX is
4. Measure FBC & serum lactate (what’s going on in tissues)
5. Start IV fluid resuscitation
6. Start accurate urine output measurements

Question 7

Which viruses & bacteria can cause bronchitis?

Answer 7

• Viruses - rhinovirus (cold), influenza

- Bacteria - strep, haemophilus influenzae

Question 8

What are the signs & symptoms of bronchitis?

Answer 8

Symptoms - dyspnoea, cough, sputum (usually), wheeze

Signs - fever (usually), tachypnoea, crackles, wheeze

Question 9

What is the pathology of bronchitis?

Answer 9

Infection & inflammation of airways

Question 10

What is the pathology of pneuomonia?

Answer 10

infection & inflammation of alveoli

Question 11

What viruses & bacteria can cause pneumonia?

Answer 11

Viruses - influenza

Bacteria - strep, staph

Question 12

What are the signs & symptoms of pneumonia?

Answer 12

Symptoms - dyspnoea, cough (usually), sputum (usually), pleurisy

Signs - fever, tachypnoea, crackles, ↓ or bronchial breath sounds (more loudly due to consolidation within area of lung)

Question 13

Is sepsis common in bronchitis or pneumonia?

Answer 13

Pneumonia

Question 14

What investigations would be done for lower respiratory tract infections?

Answer 14

• PEFR – airway constriction
• Full blood count – increased leukocytes
• U+Es
• CRP – increased in bacterial infection
• Lactate – in severe sepsis – tissues not working properly
• ABGs – hypoxia +/- hypercapnia
• CXR – shadowing consistent with pneumonia. (not good at seeing bronchitis)
• Nose & throat swabs – for viral investigations
• Sputum – for bacterial investigations

Question 15

When would you admit someone to hospital with a LRTI?

Answer 15

CURB-65 -->
- Confusion
- Urea >7mmol/L – kidney injury
- Respiratory rate >30/minute – normal is 12-16/min
- Blood pressure 1 → admit
•	If score >2 → IV treatment