Spesis And Septic Shock

Question 1

What is sepsis and septic shock according to the sepsis 3 guidelines?

Answer 1

Sepsis is life threatening organ dysfunction caused by dysregulated host response to infection (total SOFA score >2 consequent to infection

Septic shock can be identified with a clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP >65mmHg and having serum lactate of >2mmol/l despite adequate volume resuscitation

Question 2

Why is sepsis so important as a cause of morbidity and mortality?

Answer 2

Sepsis eg SOFA score >2 reflects an overall mortality risk of ~10% in general hospital population with suspected infection

Septic shock patients have a mortality of 40%

Question 3

How is the qSOFA used?

Answer 3

Systolic BP <100mmHg
Outcome poor if > or = 2
Fast breathing (RR >22/min)
Altered mental status

Question 4

What is the pathophysiology of sepsis? Including why some infections present differently in different circumstances

Answer 4

Sepsis originates from a breach of integrity of a host barrier (physical or immunological) and organism enters bloodstream

Results in uncontrolled inflammatory response, and then features consistent with immunosuppression eg loss of delayed HS, inability to clear infection, predisposition to nosocomial infection.

3 phases: release of bacterial toxins, release of mediators, effects of specific excessive mediators (pro inflammatory or anti inflammatory)

Usually there is a balance, however if it rips can lead to septic shock with multi organ failure and death, or immunoparalysis with uncontrolled infection and multi organ failure

Question 5

How does sepsis and septic shock present?

Answer 5

Sepsis: general features
Fever >38, hypothermia! Tachycardia, tachypnoea, altered mental status, hyperglycaemia. Leucocytosis or leukopenia, high CRP and prolactin, hypotension
Organ dysfunction: hypoxaemia, oliguria, thrombocytopenia, hyperbilirubinaemia

Presentation depends on host eg age, co morbidities, immunosuppression, previous surgery esp. splenectomy and also depends on organism, environment eg occupation, travel, hospitalisation

Question 6

What are the principles of management of sepsis using the sepsis 6?

Answer 6

Take 3

• blood cultures
• blood lactate
• urine output

Give 3

• oxygen sats 94-98%
• IV Antibiotics
• IV fluid challenge

2A, 2B, 2C
(Antibiotics, air, blood culture, blood lactate, crystalloid bolus, catheter)

Question 7

What are the individual components of the sepsis 6 and why are they important?

Answer 7

Blood culture - make microbiological diagnosis

Lactate - marker of generalised hypoperfusion/severe sepsis/poorer prognosis

Urine output - if low - renal dysfunction

Antibiotics - not always possible to determine cause and early treatment gives better prognosis

Fluid - to increase perfusion

Oxygen - reduces hypoxia and oxygen flow to tissues, corrects acid base balance

Question 8

Why is empirical antibiotic therapy important in patients presenting with sepsis?

Answer 8

May not be able to determine cause, may take too long to determine organism - time is life - and empirical treatment allows for treating these patients to take place quickly, possibility giving them the chance to begin recovery before it is too late