General Medicine > Sepsis > Flashcards

Sepsis Flashcards

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1
Q

What is sepsis?

A

A life-threatening organ dysfunction caused by a dysregulated host response to infection.

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2
Q

What differentiates sepsis from uncomplicated infection?

A

Organ dysfunction

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3
Q

How is organ dysfunction defined in sepsis?

A

An increase in SOFA score ≥ 2 points

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4
Q

What is the underlying pathophysiology of sepsis?

A

Dysregulated inflammatory and immune response leading to tissue injury and organ failure

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5
Q

What are the key systemic effects of sepsis?

A

Tissue ischaemia, immune suppression, apoptosis, cytopathic injury, cell death pathways

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6
Q

Why does tissue ischaemia occur in sepsis?

A

Due to microvascular dysfunction and hypotension

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7
Q

What happens to the immune system in sepsis?

A

Initial hyperinflammation followed by immune suppression

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8
Q

Why are septic patients prone to secondary infections?

A

Because of immune suppression and lymphocyte apoptosis

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9
Q

What is septic shock?

A

A subset of sepsis with circulatory and metabolic abnormalities causing increased mortality

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10
Q

Clinical definition of septic shock?

A

Sepsis with persistent hypotension requiring vasopressors to maintain MAP ≥65 mmHg and lactate >2 mmol/L despite adequate fluids

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11
Q

What type of shock is septic shock?

A

Distributive shock

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12
Q

Why is lactate elevated in septic shock?

A

Due to tissue hypoperfusion and anaerobic metabolism

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13
Q

Most common cause of death in septic shock?

A

Multi-organ dysfunction syndrome (MODS)

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14
Q

What is the first priority in managing sepsis?

A

Early recognition and early treatment

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15
Q

First-line treatment once sepsis is suspected?

A

Broad-spectrum antibiotics within 1 hour

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16
Q

What must be done before giving antibiotics (if possible)?

A

Blood cultures

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17
Q

Initial fluid of choice in sepsis?

A

Crystalloids (e.g. normal saline or balanced fluids)

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18
Q

When are vasopressors indicated?

A

If hypotension persists after adequate fluid resuscitation

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19
Q

First-line vasopressor in septic shock?

A

Noradrenaline (norepinephrine)

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20
Q

Target mean arterial pressure (MAP) in septic shock?

A

≥ 65 mmHg

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21
Q

Why is sepsis considered a medical emergency?

A

t has high mortality and outcomes depend on early intervention

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22
Q

Can sepsis present without fever?

A

Yes – especially in the elderly and immunocompromised

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23
Q

Common sources of sepsis?

A

Lung, urinary tract, abdomen, skin, intravascular lines

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24
Q

Why is source control important in sepsis?

A

Antibiotics alone are insufficient without removing the infection source

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25
Hypotension + raised lactate despite fluids = ?
Septic shock
26
What is sepsis?
Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection.
27
How is organ dysfunction defined in sepsis?
An increase in SOFA score ≥2 points from baseline.
28
What is the purpose of scoring systems in sepsis?
To predict severity, risk of deterioration, and mortality, not to diagnose sepsis alone.
29
What is qSOFA?
A bedside screening tool to identify patients with suspected infection at high risk of poor outcomes.
30
What are the three qSOFA criteria?
RR ≥22/min Altered mental state (GCS <15) Systolic BP ≤100 mmHg
31
What does a qSOFA score ≥2 indicate?
High risk of poor outcome and mortality → urgent assessment and escalation.
32
Where is qSOFA mainly used?
Outside ICU (ED, wards, pre-hospital settings).
33
Limitation of qSOFA?
Low sensitivity — a normal qSOFA does not exclude sepsis.
34
What is NEWS (National Early Warning Score)?
A physiological scoring system to detect clinical deterioration in hospitalised patients.
35
What parameters are included in NEWS?
Respiratory rate Oxygen saturation Supplemental oxygen Temperature Systolic BP Heart rate Level of consciousness (AVPU)
36
Why is NEWS important in sepsis?
It detects early deterioration and prompts timely escalation of care.
37
Which is more sensitive for deterioration: qSOFA or NEWS?
NEWS is more sensitive; qSOFA is more specific.
38
Can scoring systems replace clinical judgment?
No. They must always be used with clinical assessment.
39
What investigations help confirm sepsis after clinical suspicion?
Blood cultures Lactate FBC, U&E, CRP Imaging (e.g. CXR, CT)
40
What lactate level suggests severe sepsis/shock?
Lactate ≥2 mmol/L (especially if persistent).
41
What defines septic shock?
Sepsis with persistent hypotension Requiring vasopressors to maintain MAP ≥65 mmHg Lactate >2 mmol/L despite fluids
42
Why is early recognition of sepsis critical?
Early antibiotics and resuscitation reduce mortality.
43
What is the key principle in sepsis management?
Early identification + early treatment of the source.
44
Are the signs and symptoms of sepsis specific?
No. They are non-specific and vary depending on the organ systems involved.
45
What skin signs may be seen in sepsis?
Skin mottling Flushed skin Delayed capillary refill Rash
46
What cardiovascular signs are seen in sepsis?
Hypotension Tachycardia Arrhythmias
47
What central nervous system features suggest sepsis?
Confusion Delirium Seizures Altered level of consciousness Cognitive decline
48
What respiratory signs can occur in sepsis?
Tachypnoea Cough Sputum production Apnoea
49
What renal manifestations are seen in sepsis?
Oliguria Anuria
50
What gastrointestinal symptoms may occur in sepsis?
Ileus Absent bowel sounds Diarrhoea
51
What temperature abnormalities suggest sepsis?
Fever >38.3 °C Hypothermia <36 °C
52
Are laboratory tests diagnostic of sepsis?
No. They are non-specific and support clinical suspicion.
53
Why do laboratory abnormalities occur in sepsis?
Due to infection, tissue hypoperfusion, and organ dysfunction.
54
Which organ function tests may be deranged in sepsis?
Creatinine (renal dysfunction) Liver function tests Coagulation studies Full blood count
55
What white cell count abnormalities are seen in sepsis?
Leukocytosis or Leukopenia
56
Why can hyperglycaemia occur in sepsis?
Stress response with increased catecholamines and cortisol.
57
What inflammatory markers are commonly elevated in sepsis?
C-reactive protein (CRP) Procalcitonin
58
What lactate level is concerning in sepsis?
Lactate ≥2 mmol/L, indicating tissue hypoperfusion.
59
What does raised procalcitonin suggest?
Bacterial infection and systemic inflammatory response.
60
Can normal lab results exclude sepsis?
No. Normal labs do not rule out sepsis.
61
Are CRP and procalcitonin routinely used in the emergency centre for sepsis?
No. They are not routinely used in EC settings.
62
Where are CRP and procalcitonin most useful in sepsis?
In the ICU, where they have diagnostic and prognostic value and can be trended over time.
63
Does a positive microbiology result confirm sepsis?
It is highly supportive, but not required to make the diagnosis.
64
Why is microbiological confirmation not required for sepsis diagnosis?
Because organisms are often not immediately identified, and waiting may delay life-saving antibiotics.
65
What is the key principle regarding antibiotics and cultures in sepsis?
Obtain cultures before antibiotics, but do not delay treatment.
66
Which culture should be obtained before starting antibiotics in suspected sepsis?
Blood cultures.
67
How many blood culture sets are ideally taken in sepsis?
At least two sets from different sites (where possible).
68
Can sepsis occur with negative cultures?
Yes. Culture-negative sepsis is common.
69
When should special microbiological testing be considered in sepsis?
Travel to endemic areas Contact with confirmed cases Strong clinical suspicion
70
Which infections require special testing in relevant clinical contexts?
Rabies Malaria Viral haemorrhagic fevers Meningococcal meningitis COVID-19
71
Why is malaria important to consider in septic patients?
It can mimic bacterial sepsis and requires specific treatment.
72
What is meant by source-guided microbiological testing?
Selecting investigations based on the suspected site of infection.
73
Which specimens may be sent for source-guided testing in sepsis?
Sputum CSF Pleural fluid Intraperitoneal fluid Synovial fluid Urine
74
Why is identifying the source of sepsis important?
It allows targeted antimicrobial therapy and source control.
75
Should antibiotics be changed once culture results are available?
Yes — de-escalate to targeted therapy when sensitivities are known.
76
What types of infections can cause sepsis?
Bacterial Viral Fungal
77
How should infections be confirmed in suspected sepsis?
By using the appropriate culture medium guided by clinical clues.
78
Which type of infection is the most common cause of sepsis?
Bacterial infections.
79
Can viral and fungal infections cause sepsis?
Yes — especially in immunocompromised patients.
80
What should guide imaging choices in sepsis?
History and physical examination.
81
What imaging modalities are commonly used in sepsis?
Chest X-ray Ultrasound CT scan
82
Why is a chest X-ray performed in sepsis?
To identify pulmonary sources such as pneumonia.
83
What is the role of ultrasound in sepsis?
Fluid assessment Identify sources such as cholecystitis or pyelonephritis
84
When is CT imaging useful in sepsis?
When the source is unclear or deep-seated infection is suspected.
85
What are the core management principles of sepsis?
Identification Restore tissue perfusion Locate and treat the infectious source
86
Why is early identification of sepsis important?
It improves survival and reduces mortality, especially in septic shock.
87
Why are IV fluids given in sepsis?
To restore tissue perfusion and treat hypovolaemia.
88
How should fluid resuscitation be guided in sepsis?
MAP GCS Urine output Initial lactate Capillary refill time POCUS IVC assessment
89
What initial fluid bolus is recommended in sepsis?
30 mL/kg crystalloid, per Surviving Sepsis Campaign 2018.
90
Why should fluids be given judiciously?
To avoid fluid overload and its complications.
91
When are vasopressors indicated in sepsis?
If persistent hypotension remains despite adequate fluids.
92
Which vasopressor is recommended first-line in septic shock?
Adrenaline (epinephrine).
93
What MAP target should be maintained in septic shock?
MAP ≥65 mmHg.
94
What is the oxygen target in sepsis?
Maintain SpO₂ >90% using supplemental oxygen as needed.
95
What is source control in sepsis?
Elimination of the infectious source.
96
What interventions may be required for source control?
Incision and drainage of abscess Debridement of necrotic tissue Laparotomy Amputation (if required)
97
When should source control ideally occur?
Within 12 hours of diagnosis.
98
What is the effect of delayed antibiotics in sepsis?
Decreased survival.
99
When should antibiotics be started in sepsis?
Within 1 hour of diagnosis.
100
What type of antibiotics should be started initially?
Broad-spectrum antibiotics, guided by local resistance patterns.
101
What should be done once culture results are available?
Streamline (de-escalate) antibiotics based on sensitivities.
102
Why is antibiotic de-escalation important
To reduce antibiotic resistance and toxicity.
103
Is steroid use routine in septic shock?
No — it is controversial and reserved for selected patients.
104
In which patients should steroids be considered in sepsis?
Refractory shock Chronic steroid use Concomitant adrenal suppression COVID-19 patients requiring supplemental oxygen
105
Why might steroids help in refractory septic shock?
They address relative adrenal insufficiency and improve vasopressor responsiveness.
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