Sepsis exam questions for medical finals, OSCEs and MRCP PACES
Define the term ‘systemic inflammatory response syndrome’ (SIRS)
- Systemic response to various insults including infection, trauma, surgery, burns; includes two or more of the following:
- Respiratory rate (RR) >20 or PaCO2 <4.3 kPa
- Heart rate (HR) >90
- Temperature >38.3 oC or <36 oC
- White cell count (WCC) >12 or <4 x 109/L
- Acutely altered mental state
- Glucose >8.3 mM (in the absence of diabetes mellitus)
Define the term sepsis
- Systemic response to infection ie SIRS + source of infection
Define the term severe sepsis
- Sepsis + organ dysfunction or tissue hypoperfusion
Define the term septic shock
- Sepsis + persistent hypoperfusion despite adequate fluid resuscitation (20 ml/kg bolus of crystalloid)
List three broad categories of risk factors for sepsis
- In-dwelling devices
- Recurrent antibiotic therapy
What six steps should be taken on recognition of sepsis?
- Oxygen titrated to achieve SpO2 94-98% or 88-92% if known to have COPD
- Check lactate
- Take blood cultures
- Give IV antibiotics
- Commence IV fluid resuscitation
- Monitor urine output
What is the purpose of checking lactate levels?
- Hyperlactataemia acts as a marker of tissue hypoperfusion suggesting severe sepsis (>2 mM) or septic shock (>4 mM)
- In addition, the resulting high anion gap metabolic acidosis has negative effects on cellular and organ function
What antibiotics should be commenced on recognition of sepsis?
- If the source is known, give the appropriate empirical IV antibiotic(s) as per local guidelines
- For sepsis of unknown origin, give the appropriate broad-spectrum IV antibiotic(s) as per local guidelines e.g. piperacillin + tazobactam (tazocin) + gentamicin; once the source has been identified, switch to the appropriate empirical IV antibiotic(s) as per local guidelines
In addition to antibiotics, what action may also be required to target the underlying infection?
- Source control
What approach should be taken to fluid resuscitation in sepsis?
- Guided by clinical context
- Give boluses of crystalloid 500-1000 ml IV and re-assess after each
- Patients with severe sepsis should receive a minimum of 20 ml/kg
- Patients with septic shock often require up to 60 ml/kg
What medication can be given to control fever in sepsis?
- Anti-pyretics e.g. paracetamol 1 g PO +/- ibuprofen 400 mg PO if no contraindications
List the three aims of EGDT in sepsis.
- 1: CVP >8 mmHg
- 2: MAP >65 mmHg or SBP >90 mmHg
- 3: ScvO2 >70%
Outline the possible complications of sepsis.
- Respiratory failure
- Cardiac failure
- Renal failure
- Hepatic failure