Sepsis

Week 3

t/f: you can only have sepsis if you have a confirmed or suspected infection of some sort

true

what is SIRS

systemic inflammatory response syndrome

t/f: fever is always the first sign of infection in the elderly

false: often the elderly won’t have a fever, but they will have a altered mental status

what is sepsis syndrome a consequence of?

excessive inflammation

t/f: if there is bacteria in the blood, the patient has sepsis

false: you need an inflammatory response for it to be classified as sepsis

what are the 2 stages/conditions of sepsis?

sepsis and septic shock

is the only thing that derives SIRS and sepsis is that sepsis has an infection?

no, sepsis also includes organ dysfunction

what is sepsis?

a life-threatening acute organ dysfunction due to a dysregulated host response to infection

what is the difference between sepsis and septic shock

sepsis = dysregulated infection response that leads to acute organ dysfunction

septic shock = sepsis + hypovolemia despite fluids being given

what criteria/assessment is followed to make the sepsis diagnosis?

SOFA (sequential organ failure assessment) score

the SOFA score can help predict what?

ICU mortality

what organ fxn does the SOFA test evaluate

liver fxn, endothelium, CNS

to diagnose sepsis, do you use SOFA or SIRS assessments?

SOFA

is there such thing called severe sepsis?

no - not according to the new definitions

what assessments are used to determine if a pt has an infection

SIRS

qSOFA evalutes what 3 things?

mental status, systolic pressure, RR

what locations don’t have immune cells

eyes and joints

what are PAMPs

pathogen associated molecular pattern

what are DAMPs

damage associated molecular pattern

what are PRR

pattern recognition receptors

what are DAMPs associated with?

tissue injury

t/f: DAMPs are released when the pathogens are damaged ?

false: PAMPs are released when bacteria/pathogens are damaged

what is the role of interleukins

communicate between immune cells

are LPS present in gram negative or gram positive bacteria?

gram negative

during inflammation, does vasoconstriction or vasodilation occur?

vasodilation

does DAMPs or PAMPs amplify the immune response?

DAMPs

what occurs in the first stages of sepsis?

inflammation and vasodilation

what is the bodies response to vasodilation and low BP?

increase HR

if a pt has sepsis, will they have cool and pale skin or warm and red skin?

warm and red skin - this is due to the vasodilation

does cold shock develop during septic shock?

yes, but warm shock occurs first before before cold shock

are you in septic shock if you have a ‘warm’ shock?

no, you are in a septic state

how is septic shock treated?

vasopressor medications

what is DIC?

disseminated intravascular coagulation

can endothelial injury occur due to systemic inflammation? why or why not?

yes; damaged endothelial cell tight junctions —> leakage of fluid into the extravascular space —> exposure of coagulation factors to collagen and TF activating intravascular coagulation

what is a complication of sepsis?

DIC

bacteremia vs toxemia

bacteremia = bacteria in the blood

toxemia = toxins in the blood

t/f you must have bacteria in the blood to cause sepsis?

false, a sepsis can also be caused by toxins that cause a large inflammatory response

what is triggered after PAMPs are recognized?

an inflammatory

do gram positive or negative bacteria produce exotoxins?

gram-positive

can inflammation cause tissue necrosis

yes

if the nail blanch test is >5 sec, is the pt in cold or warm shock?

cold

what are 2 reasons for crackles in the lungs?

pneumonia and pulmonary edema

what is included in the sepsis 6 bundle

deliver high flow O2

draw blood culture

begin empiric broad-spectrum abx

begin rapid IV resuscitation (to increase the BP)

obtain serum lactate

monitor urine output and administer vasopressors if necessary

sepsis 6 bundle should be completed within how long

1 hr

what must be done if the lactate is above 2

administer vasopressors

what 4 things must be considered with abx therapy?

primary site of the infection

local hospital abx sensitivities

sensitivites of bacteria previously grown from the possible sites of bacteremia

readjustment based on the blood culture results

what is desquamation?

skin peeling

when does aerobic glycolysis shift to anaerobic glycolysis creating lactic acidosis? (cold or warm shock)

cold shock

weak and feeble pulse is a characteristic for what type of shock

cold shock

bounding pulse is a characteristic of what type of shock?

warm shock

what is the role of endothelial layer?

to prevent collagen fibers and tissue factors from coming into contact with coagulation factors in blood

why does DIC occur in sepsis?

Damage endothelial cell tight junctions→leakage of fluid into the extravascular space → exposure of coagulation factors to collagen and TF activating intravascular coagulation

What occurs when PAMPs are released?

PAMPs → immune response → inflammation → death of healthy cells → DAMPs are released → inflammation cascade is amplified

what are 2 coagulation factors in the blood?

von Willebrand factor and factor VII

why are certain exotoxins termed as superantigens?

the proteins directly stimulate the T cells to release cytokines, instead of stimulating APC that then stimulate the T cells

what are 2 superantigens?

staphylococcus aureus and streptococcus pyogenes

what receptors recognize PAMPs?

PRR

what is the role of PRRs?

to recognize PAMPs and DAMPs and release signals to warn the body of the invading pathogens

does TLR4 recognize gram-negative or gram-positive bacteria?

gram-negative

does TLR2 recognize gram-negative or gram-positive bacteria?

gram-positive

TLR4 and TLR2 cause the release of what?

pro-inflammatory cytokines

staphylococcus aureus releases what toxin?

TSST-1 (toxic shock syndrom toxin 1)

streptococcus pyogenes release what toxin?

SPEA (streptococcal pyrogenic exotoxin A)

what has to be assessed in the bedside evaluation for sepsis?

vital signs, o2 saturation, mental status, cap refill and look for mottling of the skin

what does mottling mean?

bluish, purple, or red lace-like blotches on the skin

if the cap refill is > ____ sec, the odds ratio of dying at 14 days increases to 18

5

there is a greater likelihood of a fatal outcome if skin mottling occurs what area of the body

around the knee cap