Pathophysiology and Treatment of Sepsis Flashcards Preview

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Flashcards in Pathophysiology and Treatment of Sepsis Deck (24)
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1
Q

Sepsis

A

Life-threatening organ dysfunction caused by a dysregulated host response to infection

2
Q

Septic shock

A

A subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone

3
Q

Populations at greater risk

A

• Very young (< 1 year) and older adults (>75 years) or
the very frail
• Those with impaired immune system due to illness or medication
• Those who have had surgery/invasive procedure in last 6 weeks
• Anyone with breach of skin integrity (cuts, burns, blisters, skin infection
• People who misuse drugs intravenously
• People with indwelling lines or catheters
• Women who are pregnant, have given birth or had a termination of pregnancy or miscarriage in last 6 weeks
• Neonates

4
Q

Breach of Host Barrier Integrity physical barriers

A

• Physical barriers – Skin

– Mucous membranes

5
Q

Breach of Host Barrier Integrity obvious physical breaches

A
– Catheters
– Wounds
– Burns
– Thorn pricks 
– Insect bites
6
Q

Breach of Host Barrier Integrity subtle breaches

A

– Epithelial cell damage

7
Q

Main Factors Affecting Infection

A
  • Virulence of pathogen • Bioburden
  • Portal of entry
  • Host susceptibility
  • Temporal evolution
8
Q

endotoxin

A

part of a bug that can elicit inflammatory response

9
Q

exotoxin

A

exotoxin is something that is secreted by the bug

10
Q

Host Innate Immunity

A

First line of defence against pathogenic insult

11
Q

Main immune cell molecules

A

– Toll-like receptors (TLRs)
– Phagocytes
– Complement
- LPS

12
Q

inflammatory markers

A

– Interleukins (ILs)

– Tumour necrosis factor alpha (TNFα) – Reactive oxygen species (ROS)

13
Q

Effects of TNFα and IL-1 on the body = Acute phase response

A
  • Fever
  • Hypotension
  • Increased HR
  • Corticosteroid and ACTH release
  • Release of neutrophils
14
Q

Effects of TNFα and IL-1 on the CVS

A
  • Generalised vasodilation (NO.)
  • Increased vascular permeability(activated leukocytes)
  • Intravascular fluid loss
  • Myocardial depression (tissue hypoxia)
  • Circulatory shock
15
Q

who to screen for sepsis?

A
  1. Presents with unexplained illness
  2. Clearly looks unwell and has a likely infective cause OR presents with (or subsequently deteriorate to) an individual parameter score of 3 or aggregate score of 4 or higher on NEWS/ locally derived equivalent
16
Q

General Prescribing Considerations in Sepsis

A

• patient history (underlying disease, immune status, prior antibiotic use, prior infection, or colonization with multidrug-resistant organisms)
• potential source of infection
• microbial resistance patterns within the
community, hospital, or intensive care unit (ICU)
• patient organ dysfunction
• associated drug toxicities (such as nephrotoxicity with aminoglycosides)

17
Q

Respiratory

A

cover with broad spectrum, consider pseudomonas and MRSA

18
Q

Urine

A

cover for G-ve and Pseudomonas

19
Q

Abdo

A

cover for G-ve/+ve and anaerobes

20
Q

Soft tissue/joint cover for

A

G-ve/+ve/anaerobes

21
Q

CNS

A

cover for meningitis

22
Q

Primary Care role

A
  • Ensure GPs and ambulance services can give antibiotics to patients with high risk criteria in the pre-hospital settings in location where transfer time is more than 1 hour
  • Ensure patients know of diagnosis and follow- up
23
Q

• Short-term complications

A

organ dysfunction, coagulation disorders

24
Q

• Longterm dysfunctions

A

neurological dysfunction, increased mortality rate for at least a year