acute sepsis in ER

Question 1

What is sepsis?

Answer 1

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

Question 2

how do microorganisms trigger the inflammatory response?

Answer 2

• Gaining entry into the host (e.g. via respiratory, GI, urogenital, skin)
• Adherence to host cells (e.g. via cell surface adhesion molecules, fimbriae/pili)
• Invasive into host cells / mucosal surfaces (e.g. via enzymes such as collagenase and hyaluronidase)
• This would then result in inflammation (either pyogenic or granulomatous)

Question 3

what are the physiological features of sepsis?

Answer 3

• Respiratory: Raised respiratory rate (tachypnoea). Peri-capillary oedema & reduced pulmonary compliance (fluids leaking into interstitial tissues)
• Cardiac: Low blood pressure (due to vasodilation and increased capillary leakage). This would result in tachycardia & end-organ damage (kidneys, liver, and brain)
• Central Nervous System: As a result of reduced blood perfusion to the brain, patients can present with confusion, drowsiness, slurred speech, agitation, anxiety, and reduced level of consciousness.
• Renal: As a result of reduced blood transfusion to the kidneys, there is reduction in urine output.
• Pyrexial (hypothalamic response to infection) BUT remember hypothermia for elderly or even normal temperature for children/immunocompromised patients!

Question 4

who is at risk of sepsis?

Answer 4

• Very young (< 1 year old).
• Elderly (>75 years) or very frail.
• Pregnant, post-partum (within last 6 weeks).
• Patients with impaired immune system due to illness

Question 5

how is sepsis diagnosed?

Answer 5

Blood cultures

Question 6

what is the sespsis 6?

Answer 6

SEPSIS 6 within the first hour!
IN: oxygen, antibiotics, fluids (only if appropriate)
OUT: blood cultures, lactate & Hb, urine output.
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