Sepsis

Question 1

What is SIRS?

How is it defined?

Answer 1

Systemic Inflammatory Response Syndrome

> = 2 of :

• temp >38 or 90bpm
• RR>20/min or PaCO2 12000 cells/mm^3 or 10% immature (band) forms

Question 2

What are the causes of SIRS?

Answer 2

1: INFECTION

-non-infectious causes of SIRS:
Pancreatitis
Burns
Multiple Trauma
Ischemia
Hemorrhagic shock

Question 3

What is sepsis?

Answer 3

SIRS (severe inflammatory response syndrome) due to proven/probable infection.

Question 4

Define severe sepsis

Define severe shock

Answer 4

1. Severe sepsis:
   - organ dysfunction
   - hypotension (syst bp 40 from baseline)
   - hypoperfusion (lactic acidosis)
2. Septic shock:
   - severe sepsis with hypotension that doesn’t respond to fluid resuscitation and requires pressors

Question 5

List the following in order of increasing disease severity:

infection, sepsis, septic shock, severe sepsis, SIRS

Answer 5

• INFECTION
• SIRS
• SEPSIS
• SEVERE SEPSIS
• SEPTIC SHOCK

Question 6

Explain the ‘stranger-danger’ principle:

Answer 6

stranger= PAMPs
danger=DAMPs (cell death)

• -> bind TLRs (innate cells)–> activates:
• cytokines
• chemokines
• adhesion molecules
• enzymes
• coagulation factors
• immunoreceptors

Question 7

What effects to cytokines have?

Answer 7

• increase vascular permeability
• increased local blood flow
• infiltration of PMNs, compliment, antibacterial proteins

= Sx of inflammation (redness, warmth, pain)

Question 8

What anti-inflammatory cytokines help keep the immune response local and controlled?

What cytokine agonists aid in anti-inflammation?

What antiinflmmatory hormones are released?

Answer 8

• IL-4, IL-10
• IL-1R, TNF-R
• cortisol

Question 9

How do you treat sepsis?

Answer 9

1. broad-spectrum antibiotics

2. source control

Question 10

What is ‘early goal directed therapy”?

Answer 10

• ensure adequate organ perfusion–> resuscitation in ER within 6 hrs of presentation
• goal directed bc specific target that indicate ‘near normal’ physiologic funx