Sepsis

Question 1

What is the key cause of sepsis?

Answer 1

-bacteria enters the blood stream (bacteraemia) causing a systemic inflammatory response
can enter the blood stream by:
-immune system overwhelmed by infenction
-immune system is comprimised (chemotherapy etc)
-immune system gets bypassed (surgery, IV drugs etc.)

Question 2

What does the inflammation do that causes problems?

Answer 2

• widespread vasodilation
• increased capillary permeability and tissue oedema
• endothelial damage
• changes to clotting cascade causing hypercoagulability
• diffuse microvascular clotting leading to reduced blood flow in organs => organ dysfunction

Question 3

Signs and symptoms in early stages of sepsis?

Answer 3

• flu-like symptoms
• fever (temp >38)
• flushed appearance
• some level of angioedema
• tachypnoea (>20/m), and tachycardia (>90bpm)
• GI cramps, diarrhoea and vomiting
• reduced urine output
• malaise ((general feeling of discomfort)

Question 4

Signs and symptoms of late stage sepsis?

Answer 4

• cool, pale, mottled skin - temp may be <35 or >38
• tachypnoea and tachycardia
• arrhythmias SVT or VT - can be bradycardic
• hypotension (systolic <90)
• ALOC
• confirmed bacteraemia/elevated wbc count

Question 5

What is septic shock?

Answer 5

sepsis-induced hypotension presisting despite adequate fluid resuscitation
metabolic acidosis

Question 6

How would you treat a septic patient?

Answer 6

• PPE (may be infectious)
• fluid resus (20-30mL/kg)
• highflow oxygen and respiratory support for hypoxaemia
• antibiotics and vasopressors (adrenaline) under consult of ICP

Question 7

How does sepsis lead to SIRS (systemic inflammatory response syndrome), and what can SIRS then lead to?

Answer 7

• sepsis leads to SIRS if it is not effectively treated

- lead to multiple organ dysfunction syndrome (MODS) if not treated effectively due to diffuse microvascular clotting

Question 8

What is ARDS? Explain the pathophysiology of ARDS.

Answer 8

• acute respiratory distress syndrome
• pulmonary causes result in damage to exchange membrane causing increased permeability and an inflammatory response
• causes tissue pulmonary oedema and increased space between alveoli and capillary

Question 9

Meningococcal Septicaemia:

• Pathophysiology?
• Clinical Features?
• Treatment?

Answer 9

• severe sepsis caused by particular bacteria with rapid manifestations
• clinical features: photophobia, neck stiffness, fever, cold hands and feet, non-blanching purpuric rash, ALOC
• treatment: PPE, consult with ICP, administer benzyl-penicillin