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Infection > Lecture 5 - Acute Sepsis > Flashcards

Lecture 5 - Acute Sepsis Flashcards

1
Q

What is the definition of Sepsis?

A

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

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2
Q

What is the definition of Septic shock?

A

A subset of sepsis where particularly profound circulatory, cellular and metabolic abnormalities substantially increase mortality

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3
Q

In simple terms what is sepsis?

A

It is characterised by inflammation

It’s where the reactions of the immune system to an INFECTION has become dysregulated/uncontrolled

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4
Q

What is bacteremia?

A

Presence of bacteria in the blood

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5
Q

What are the 5 signs of inflammation?

A

Rubor
Tumor
Calor
Dolor
Functio laesa

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6
Q

What is the pathophysiology of sepsis?

A

Infection stimulates Inflammatory response:
-Vasodilation (Rubor and Calor)
-Increased vascular permeability/capillary leakage (Tumor + Dolor)
-AMPLIFICATION of immune response (macrophages produce cytokines stimulating this)

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7
Q

What are the ways that microorganisms trigger the inflammtory response?

A

Gain entry into host
Adherence to host cells
Invasion into host cells/mucosal surfaces

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8
Q

What is the ABCDE effects of spepsis on organ systems?

A

Airways
Breathing
Circulation
Disability
Exposure

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9
Q

What airway issues may occur with sepsis?

A

No specific affect unlesss infection arises in throat or neck
Decreased consciousness may be at risk of problems of airways

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10
Q

What breathing issues may occur with sepsis?

A

Tachypnoae (Raised respiratory rate)

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11
Q

What circulation issues may occur with sepsis?

A

Hypovolaemia
Hypotension
Tachycardia
End organ damage

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12
Q

What disability issues may occur with sepsis?

A

Confusion
Drowsiness
Slurred speech
Decreased consciousness

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13
Q

What Exposure issues may occur with sepsis?

A

High temperature (Fever)
Elderly may get hypothermia

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14
Q

Why can respiratory issues (Tachypnoea) arise in sepsis?

A

Increased leakage of fluid out of capillaries into tissues like lungs decreases lungs ability for gas exchange
Respiratory rate increases to counteract this

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15
Q

Why can cardiac/circulatory issues arise in sepsis?

A

Vasodilation and increased capilary leakage means more fluid leaves blood
Results in hypovolaemia and hypotension
Tachycardia occurs, heart beats fastener to try and maintain the blood pressure/cardiac output
Organs don’t receive enough O2 blood so damage

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16
Q

Why may confusion and disability of the CNS occur in sepsis?

A

Reduced blood flow/perfusion to the brain

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17
Q

Why do renal issues occur in sepsis?

A

Reduced blood perfusion to kidney
Reduced volume of fluid in blood reduces urine output

18
Q

Which groups of people are especially at risk to sepsis?

A

Very young (immune system not fully developed)
Elderly (immune systems weak)
Pregnant/6weeks post partum (partially suppressed immune system)
Immunocompromised patients (drugs or illness)

19
Q

What system is used for screening for sepsis and when should it be used?

A

NEWS2 system
When score is 5 or more

20
Q

Which group of people is the NEWS2 system NOT valid for?

A

Pregnant adults
Children < 16yrs

21
Q

What 6 physiological measurements does NEWS2 use?

A

Respiration rate
Oxygen saturation
Systolic blood pressure
Pulse rate
Level of consciousness or new confusion
Temperature

22
Q

What does lactate levels > 2mmol/L indicate?

A

Organ dysfunction (hypoxia)

23
Q

What NEWS2 score might be indicative of sepsis?

A

5 or more

24
Q

What is Red Flag Sepsis?

A

Stage of sepsis where IMMEDIATE action needs to be taken
Organ dysfunction is highly likely and the patient is at a high risk of deterioration

25
Q

What NEWS2 score would suggest red flag sepsis?

A

7 +
Or
NEWS2 of 5 or 6 with:
-lactate > 2mmol/L
-Chemotherapy in last 6 weeks
-organ failure eviden
-looks extremely unwell
-active deterioration

26
Q

What needs to be immediately started with a patient who has red flag sepsis? (NEWS2 > 7)?

A

Sepsis 6

27
Q

What is Amber flag sepsis?

A

Stage of sepsis where urgent action within 3 hours needs to happen

28
Q

What NEWS2 score may be amber flag sepsis?

A

NEWS2 5 or 6
Or
NEWS2 1-4 AND ONE OF:

-lactate > 2mmol/L
-Chemotherapy in last 6 weeks
-organ failure eviden
-looks extremely unwell
-active deterioration

29
Q

What are the 6 tasks of Sepsis 6 that must all be done together/in short succession?

A

1.) Senior help
2.) Give O2 (if needed)
3.) Send bloods
4.) IV Antibiotics
5.) IV fluids (if needed)
6.) Monitor

30
Q

When might you give oxygen as a part of the Sepsis 6 response?

A

When SpO2 (Oxygen saturation) is below 92%

31
Q

When sending bloods what tests may be done?

A

Full Blood Count
CRP levels
Liver function test (ALT/AST)
Renal function test (Urine + Electrolytes)
Blood gas (O2 and lactate levels)

32
Q

When giving IV antibiotics what are you considering?

A

The likely cause of infection
Where entry may have happened
Try and remove source of infection

33
Q

Why do you have to be careful when considering IV fluids?

A

If Hypovolaemic give but need to do right amounts to avoid overloading the lungs
Tachycardia then give

34
Q

What happens in the monitoring stage of sepsis 6?

A

Monitor NEWS2 score
Urine output
Any deterioration
Escalation?

35
Q

In sepsis 6 remember give 3 take 3:

A

Give:
-Oxygen
-IV antibiotics
-IV Fluids
Take:
-Blood cultures
-Lactate
-Urine output

36
Q

What is a non-blanching rash?
What is commonly used to test for a blanching rash??

A

A rash that doesn’t disappear with pressure
Usually a glass is pressed against the rash, if it doesn’t disappear with pressure it is non blanching

37
Q

How can sepsis probably caused by meningitis be treated?

A

Antibiotics that can cross blood brain barrier (Ceftriaxone)
Vaccination
Prophylaxis for close contacts

38
Q

What is prophylaxis?

A

Any means taken to prevent disease like immunisation (vaccines) against disease

39
Q

What is meant by something being a notifiable disease or a notifiable microorganism?

A

Public Health England must be made aware of the case you have come across so further investigation can be done in the national interest of the countries health saftey

40
Q

What IV antibiotic is usually given as a first line of treatment with suspected sepsis?

A

Ceftriaxone

41
Q

When is Dexamethasone often administered?

A

Bacterial meningitis (could cause sepsis)

Infection (21 decks)

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