Acute Sepsis Flashcards
What is sepsis?
Sepsis is life-threatening organ
dysfunction due to a dysregulated host
response to infection
What is septic shock?
• Septic shock is persisting hypotension
requiring treatment to maintain blood
pressure despite fluid resuscitation
What is bacteraemia?
Bacteraemia is the presence of
bacteria in the blood (+/- clinical
features)
What is septicaemia?
• Septicaemia is an outdated clinical term meaning generalised sepsis • Sepsis is a serious life-threatening response to infection i.e. the terms are not interchangeable
What are methods used which could identify sepsis?
Identifying sepsis
• Clinical assessment of patients who look sick or have raised Early Warning Score (EWS)
• Clinical features suggesting source (e.g. pneumonia, UTI, meningitis, etc)
• Check for Red Flags
What is a care bundle?
Bundle - a group on intervention that when used together is proven to have better outcomes for the patient
Better for the patient
Consistency when treating patient
Efficient in terms of training delivery - everyone doing the same thing
What is a purpuric rash?
Glass against rash - doesnt disappear
Meningococcus? Septaecaemia?
What is the sepsis screening & action tool?
See slide
What are the sepsis red flags?
If any one preset - highly suspect sepsis
- Responds only to voice or pain / unresponsive
- Acute confusional state
- Systolic B.P ≤ 90 mmHg (or drop > 40 from normal) • Heart rate > 130 per minute
- Respiratory rate ≥ 25 per minute
- Needs oxygen to keep SpO2 ≥ 92%
- Non-blanching rash, mottled / ashen / cyanotic (cyanosis - purple discolouration of skin/mucous memb due to low oxygen sat)
- Not passed urine in last 18 h / UO <0.5 ml / kg / hr
- Lactate ≥ 2 mmol / l - low Berri soon to kidneys
- Recent chemotherapy
What is the sepsis 6 bundle?
- Titrate oxygen to a saturation target of 94%
- Take blood cultures.
- Administer empiric intravenous antibiotics.
- Measure serum lactate and send full blood count.
- Start intravenous fluid resuscitation.
- Commence accurate urine output measurement.
For sepsis for every hour delay giving antibiotics,morality goes up 7%
What are urgent investigations after sepsis is confirmed?
• Full blood count, Urea and Electrolytes - electrolytes to check kidneys
• EDTA bottle for PCR – organism specific eg to meningococcus
• Blood sugar
• Liver Function Tests - baseline
• C-Reactive protein (CRP) - marker of inflammation and infection, used to check if coming down after antibiotics given
• Coagulation (clotting) studies
• Blood gases - pH an lactate of blood
• Other microbiology samples (CSF, urine,
etc)
What is a cause of meningococcal meningitis?
- Bacterial pathogen Neisseria meningitidis
- Spread by direct contact with respiratory secretions
- Most people are harmlessly colonised
- In the unlucky few - rapidly progressive (and potentially fatal) disease if not recognised and treated promptly - can cause sepsis or bacteraimia if gets into blood stream
What is the inflammatory cascade?
ENDOTOXINS BINDS TO MACROPHAGES
Local - cytokines - stimulate infmallatory response to promote wound repair and recruit RE system
Systemic -cytokines released into circulation - stimulating growth factor, macrophages and platelets
Sepsis - if infection not controlled - cytokines lead to activation of humoral cascades and RE system. Circulatory insult
How can cytokines lead to multiorgan failure?
- Cytokines initiate production of thrombin and thus promote coagulation
- Cytokines also inhibit fibrinolysis
- Coagulation cascade leads to microvascular thrombosis and hence -small clots in microvascualature leading to
- Organ ischaemia, dysfunction and failure
- Microvascular injury is the major cause of shock and multiorgan failure
What is supportive and specific treatment?
Supportive - symptom relies, physiological restoration eg raise low oxygen levels
Oxygen - raise seats (supportive)
Specific = antimicrobials, antibiotics
Is say perforated appendix - surgery - if antibiotics not enough
