Sepsis Flashcards Preview

[ ESA 3- Infection and Immunity > Sepsis > Flashcards

Flashcards in Sepsis Deck (121):
1

What factors should be considered when making a diagnosis of sepsis?

Age
Physiological state
Pathological state
Social factors
Relative time

2

What needs to be established regarding pathological state in sepsis?

Any ongoing past medical history that could impact the diagnosis

3

Give two examples of ongoing medical history that could impact a diagnosis of sepsis

Diabetes
Cancer

4

What is the importance of social factors in a diagnosis of sepsis?

If they are in close contact with other people, could impact on potential source and potential for spread

5

What contributes to a diagnosis of sepsis?

History
Examination
Investigations

6

What is important when making a diagnosis of sepsis?

The process of diagnosis needs to be condensed into essential information, as a very rapid assessment needs to be made

7

What features will be seen on examination of a patient with sepsis?

Pale
Clammy
Very high temperature
Increased pulse
BP may be normal, or may be raised
Raised respiratory rate

8

How is a clinical assessment made of a patient who looks like they may have sepsis?

Using an early warning score (EWS)

9

What is a healthy EWS score?

0

10

What is considered to be a high EWS score?

3+

11

What is the EWS based on?

Basic observations;
RR
HR
Temp
BP
Conscious and alert?

12

Give three examples of clinical features suggesting a source that could be considered when making a diagnosis of sepsis

Pneumonia
UTI
Meningitis

13

What are the clinical features of sepsis?

Neck stiffness
Non-blanching rash

14

What are the red flags in sepsis?

High RR
Low BP
Unresponsive

15

What does a low BP indicate in sepsis?

Heading towards septic shock

16

What is required if a patient has red flag sepsis?

Urgent action is required; inform senior doctor for review, and send for urgent investigations

17

What is the sepsis 6 bundle?

Oxygen
Blood cultures
IV antibiotics
Fluid challenge
Lactate
Measure urine output

18

What timeline should the sepsis 6 bundle be performed on?

All needs to occur within a one hour timeline

19

What urgent investigations should be made with sepsis?

Full blood count
EDTA bottle for PCR
Blood sugar
Liver function tests
C-reactive protein
Coagulation studies
Blood gases
Other microbiology samples

20

What should be looked for in the full blood count of a sepsis patient?

Urea and electrolytes

21

What does the measurement of urea and electrolytes in a sepsis patient determine?

Renal function

22

What is C-reactive protein?

An acute phase reactant

23

What other microbiological samples should be taken in sepsis?

CSF
Urine

24

How can a diagnosis of sepsis be confirmed?

Blood culture
PCR of blood
Lumbar puncture

25

What must a blood culture investigating sepsis determine?

Antibiotic susceptibility

26

Why must a blood culture in sepsis determine susceptibility?

Because of antibiotic resistance

27

When should a lumbar puncture be done?

Only after checking contraindiciations

28

What investigations can be done subsequent to a lumbar puncture?

Microscopy and culture of cerebrospinal fluid
PCR of CSF
Glucose and protein estimation in biochemistry
Appearance
Gram stain

29

What should be assessed when looking at the appearance of a lumbar puncture sample?

Turbidity
Colour

30

How many cells should the CSF normally contain?

Virtually none

31

What colour should the CSF normally be?

Clear

32

Why is a gram stain performed following a lumbar puncture?

Most rapid way of determining likely diagnosis

33

How has the definition of sepsis changed?

Terms SIRs and severe sepsis are no longer used

34

How has the definition of sepsis not changed?

Process of recognition, and specifics of management not changed

35

What is sepsis?

Life threatening organ dysfunction due to a dysregulated host response to infection

36

What organs may be dysfunctioning in sepsis?

Kidney
Heart
Brain
Haemopoetic

37

What is meant by dysregulation of host response?

Overreaction of host to the insult of infection

38

What is septic shock?

Persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation

39

What is the prognosis of septic shock?

Imminently fatal unless treated very quickly

40

What is required in the case of septic shock?

Transfer to ICU

41

What is bacteraemia?

Presence of bacteria in the blood, with or without clinical features

42

How severe is bacteraemia?

Can be asymptomatic, or may be very unwell

43

What does bacteraemia specifically require?

Demonstration

44

How is bacteraemia demonstrated?

Blood cultures

45

What is septicaemia?

An outdated clinical term meaning generalised sepsis

46

What is the pathogen in meningococcal meningitis sepsis?

Bacteria Neisseria meningitidies

47

What kind of bacteria is meningococcal meningitis?

Gram -ve dipolococcus

48

What are the main serogroups of Neisseria meningitis?

A
B
C
W-135

49

What does the serogroup of Neisseria meningitides depend on?

The polysaccharide capsular antigen

50

What is the purpose of Neisseria meningitides polysaccharide capsular antigen?

Evades immune response by preventing phagocytosis

51

What does the outer membrane of Neisseria meningitides act as?

An endotoxin

52

How is meningococcal meningitis spread?

Direct contact with respiratory secretions

53

What % of young adults may be carriers of meningococcal meningitis?

Up to 25%

54

What is meant by being a carrier of meningococcal meningitis?

Colonised with no signs or symptoms of infections

55

What does acquisition of meningococcal meningitis lead to?

Either clearance, carriage, or invasion

56

What is the problem with young adults being carriers of meningococcal meningitis?

May spread to other people

57

How can carriers of meningococcal meningitis spread the pathogen to other people?

By aerosols and nasopharyngeal secretions

58

What can happen in a few people who are infected with meningococcal meningitis?

The infection can be rapidly progressive, invasive, and potentially fatal if not recognised and treated promptly

59

How many cases of meningococcal meningitis are there per year in England?

~1000

60

What serogroup are the cases of meningococcal meningitis in England?

Group B

61

Give an example of where other serogroups of meningococcal meningitis predominate?

Meningitis belt across Africa is the group A strain

62

What is the fatality rate of meningococcal meningitis?

~10%

63

What is happening to the fatality rate of meningococcal meningitis?

It is improving over the years

64

Why is the fatality rate of meningococcal meningitis improving over the years?

Getting better at recognising and managing

65

How can meningococcal meningitis be prevented?

Vaccination
Antibiotic prophylaxis

66

What are the vaccines available for meningococcal meningitis?

Meningococcal C conjugate vaccine
ACWY vaccine
Serogroup B vaccine

67

How effective is the meningococcal C conjugate vaccine?

Very

68

When was the meningococcal C conjugate vaccine introduced in the UK?

1999

69

What did the introduction of the meningococcal C conjugate vaccine lead to?

A dramatic drop in cases

70

Who is the ACWY vaccine for?

Originally for immunocompromised patients and travel protection, especially for middle east, but is now replacing the MenC vaccine

71

Why is the ACWY vaccine replacing the MenC vaccine?

Due to the increase in W cases in the UK

72

When was the serogroup B vaccine introduced in the UK?

Sep 2015

73

Why was a meningitis serogroup B vaccine hard to develop?

It is a very different strain in terms of vaccination, and the B capsule is poorly immunogenic and similar to neural tissue

74

What is the result of the meningitis serogroup B capsule being similar to neural tissue?

Potential side effects

75

Why are potential side effects not acceptable in a meningitis vaccine?

As you are giving it to 10,000s of people against a rare disease

76

How was the serogroup B vaccine developed?

After screening candidate subcapsular antigens from genome studies

77

How many antigens does the current serogroup B vaccine have?

4

78

When is the serogroup B vaccines given?

At 2, 4, and 12 months, and adults at increased risk

79

What has there been massive debate over regarding the serogroup B vaccine?

Millions of pounds versus a small number of cases

80

What is the result of the serogroup B vaccine introduction?

Beginning to see drop in number of cases

81

What is meant by meningitis being a notifiable disease?

Person diagnosing, e.g. GP, has to inform local Health Protection Unit of PHE of any cases

82

What happens once PHE has received notification of a meningitis case?

They decide what, if any, action to take

83

What action may PHE take on receiving notification of a case of meningitis?

Close contacts are determined, and can be given antibiotic prophylaxis and considered for vaccination

84

Why would close contacts of someone with meningitis be considered for antibiotic prophylaxis?

Break chain of transmission

85

How does giving antibiotic prophylaxis to the close contacts of a person with meningitis break the chain of transmission?

Removes strain from carriers
Short term protection for those in close contact

86

What is the inflammatory cascade intended to do?

Combat infectious stimulus

87

How does the inflammatory cascade combat an infectious stimulus?

Confine infection to produce a local abscess

88

What happens when endotoxins bind to macrophages?

They cause local and systemic effects

89

What are the local effects of endotoxins binding to macrophages?

Cytokines are released

90

What cytokines are released locally when endotoxins bind to macrophages?

Tissue necrosis factors and interleukins

91

Give an example of a tissue necrosis factor

TNF-alpha

92

Give an example of an interleukin

IL-1

93

What do tissue necrosis factors and interleukins do when released locally?

Stimulates inflammatory response, promoting wound repair and recruits RE system

94

What are the systemic effects of endotoxins binding to macrophages?

Cytokines are released into the circulation

95

What is the result of cytokines being released into the circulation?

Stimulates growth factor, macrophages, and platelets

96

What is the goal of releasing cytokines systemically?

Control of infection

97

What is the result of the infection not being controlled in sepsis?

Cascades are activated to a degree that there is insult to host

98

What do cytokines lead to in sepsis?

Activation of humoral cascades and the RE system, leading to circulatory insult

99

What does circulatory insult include in sepsis?

Disseminated intravascular coagulation and organ injury

100

What is the problem with disseminated intravascular coagulation in sepsis?

Because clotting is dysregulated, organs can loose their effective blood supply, and start to fail

101

Why do cytokines cause problems with clotting?

They initiate the production of thrombin and thus promote coagulation
Inhibit fibrinolysis

102

What happens if cytokines promote coagulation in small vessels?

It impairs circulation

103

What does the coagulation cascade lead to in sepsis?

Microvascular thrombosis

104

What does microvascular thrombosis lead to?

Organ ischaemia
Dysfunction
Failure

105

What is microvascular injury a major cause of?

Shock and multiorgan failure
Progressive necrosis

106

Why does microvascular injury lead to progressive necrosis?

Circulatory collapse means the supply to non-essential organs, such as hands and feet, is lost

107

What is sometimes required to preserve life as a result of microvascular injury in sepsis?

All four limbs need to be amputated

108

What are the specific treatments for sepsis?

Antimicrobials
Surgery

109

What antimicrobial agent should be used in sepsis?

One likely to be active against the pathogens that cause meningitis in the age group
Must be agent that penetrates into the CSF

110

Why is it important to consider the age group when looking to treat sepsis?

The causative organism is going to be different in neonates and the elderly

111

What is the emperic antimicrobial choice in sepsis?

Ceftriaxone

112

Why may surgery be required for sepsis?

Drainage
Debridement

113

Why might surgical drainage be required in sepsis?

If large collection of pus

114

Why might debridement be required in sepsis?

If lots of dead tissue, or if infected limb needs to be amputated

115

What are the supportive treatments for sepsis?

Symptom relief
Physiological restoration
Consider early referral to ITU
Sepsis six
Regular monitoring and reassessment

116

How can the symptoms of sepsis be relieved?

Pain relief
Blood if anaemia
Prevent clotting

117

When can life threatening complications of sepsis occur?

Immediately, or over next few hours/days

118

What are the life threatening complications of sepsis?

Respiratory failure
Acute kidney injury
Raised intracranial pressure
Ischaemic necrosis of digits/hands/feet

119

Can respiratory failure occur if a sepsis patient is ventilated?

Yes

120

Why may sepsis lead to acute kidney injury?

Kidney is unable to excrete urea and creatinine

121

What is the result of AKI in sepsis?

The patient is poisoned