Infection session 2 - Lecture 1 - Acute Sepsis in ED Flashcards Preview

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Flashcards in Infection session 2 - Lecture 1 - Acute Sepsis in ED Deck (15)
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1
Q

What is sepsis?

A
  • Life threatening organ dysfunction due to a dysregulated host response to infection. Represents acute physiological deterioration where the host’s immune system has over-reacted and started to compromise physiology of pt.
  • Serious life threatening response to infection
2
Q

What is septic shock?

A

-Persisting hypotension requiring treatment to maintain BP despite fluid resuscitation

3
Q

What is bacteraemia?

A

-Presence of bacterial in the blood.

4
Q

How can you recognise sepsis? (general)

A
  • Early Warning Score (3+)
  • Clinical features suggesting source (pneumonia, UTI, meningitis)
  • Check for red flags: high RR, low BP, high HR, unresponsible, fever, low I/O
5
Q

What is the sepsis 6 bundle?

A
  • Take 3, give 3
  • Oxygen
  • Fluid challende
  • Blood culture
  • Lactate (arterial)
  • IV ABX
  • Measure urine output
6
Q

What urgent investigations can you do if you suspect sepsis?

A
  • FBC, including urea (kidney function) and electrolyles
  • PCR (blood)
  • Blood sugar
  • LFT (liver function test): sugar metabolism is disturbed in sepsis
  • CRP: marker of inflammation
  • Coagulation studies
  • Blood gas: lactate levels, CO2 and O2 levels
  • Other microbiology samples: CSF, urine, swabs
7
Q

What bacteria commonly causes meningitis? What do you know about it?

A
  • Neisseria meningitidis (often referred to as meningococcus)
  • Spread via direct contact with respiratory secretions (most ppl are harmlessly colonised)
  • Gram neg
  • Causes meningitis (form of sepsis)
  • Diplococcus, outer membrane acts as an endotoxin
  • Numerous sero-groups: A B C, W
8
Q

Why are endotoxins important?

A

-Toxin (released by bacteria) into cells that have the ability to provoke an intense inflammatory response.

9
Q

Describe the inflammatory cascade

A
  • Endo-toxin binds to macrophages ==> local response
  • Local response: cytokines are released (TNF, IL1) ==> systemic response
  • Systemic response: cytokines are released into circulation, stimulation of growth factor, macrophages and platelets (goal is to control infection)
  • Cytokines lead to ==> Sepsis
  • Sepsis: cytokines lead to activation of humoral response, get circulatory insult (DIC [disseminated intravascular coagulation] and injury) and perfusion to vital organs is diminished.
10
Q

What is the relationship between sepsis and coagulation?

A
  • cytokines initiate production of thrombin: promotes coag.
  • cytokines inhibit fibrinolysis
  • coag. cascade leads to microvascular thrombosis (main cause of shock/multi-organ failure) –> organ ischaemia, DIC, dysfunction and failure
11
Q

What is a non blanching purpuric rash?

A

Red spots on skin that don’t go away when pressed. Can be (but not always) a sign of infection).

12
Q

What type of supportive treatment should you give to somebody with sepsis?

A
  • Symptom relief

- physiological restoration: sepsis 6, regular monitoring and assessment, consider early referral to ITU

13
Q

What is empiric choice of ABC for meningitis?

A

-Ceftriaxone

14
Q

Name a few life threatening complications of meningitis and (by extension) the sepsis that ensues

A
  • Irreversible hypo tension –> poor organ perfusion, loss of limbs (ischaemic necrosis of digits/hands/feet)
  • Resp failure
  • Acute kidney injury/failure (one of 1st organs affected)
  • Raised intracranial pressure
15
Q

What preventative measures are there against meningitis population wise and on a more individual basis?

A
  • Vaccination: C, ACWY, Sero group B (very new)

- ABX prophylaxis: notifiable disease, must be reported to public health England, vaccinate/ABX close contacts