Infectious diseases - sepsis Flashcards
What can also occur in sepsis in terms of clotting?
DIC
Why does lactate go up in sepsis?
Blood lactate rises due to hypoperfusion of tissues that starves the tissues of oxygen causing them to switch to anaerobic respiration.
A waste product of anaerobic respiration is lactate.
What is septic shock?
Septic shock is defined when arterial blood pressure drops and results in organ hypo-perfusion
Treat aggressively with IV fluid boluses
If IV fluids don’t improve BP/lactate then the patient should be escalated to HDU/ICU and may need inotropes
What do inotropes do?
E.g. noradrenalin
Stimulate the CV system and improve BP and tissue perfusion
Risk factors for sepsis
Very young or old patients (under 1 or over 75 years)
Chronic conditions such as COPD and diabetes
Chemotherapy, immunosuppressants or steroids
Surgery or recent trauma or burns
Pregnancy or peripartum
Indwelling medical devices such as catheters or central lines
Presentation of sepsis
Tachypnoeic
Tachycardic
Hypotensive
Fever
Signs of potential sources such as cellulitis, discharge from a wound, cough or dysuria
Non-blanching rash can indicate meningococcal septicaemia
Reduced urine output
Mottled skin
Cyanosis
Arrhythmias such as new onset atrial fibrillation
When may observations be normal in sepsis?
Neutropenic or immunosuppressed patients may have normal observations and temperature despite being life threatening unwell
Investigations for suspected sepsis
FBC U&Es LFTs CRP Clotting Blood cultures
ABG/VBG - for lactate, pH and glucose
Investigations for source of infection:
- Urine dipstick and culture
- CXR
- CT scan if intra-abdominal infection or abscess suspected
- LP for suspected meningitis or encephalitis
Management of sepsis
Patients should be assessed and treatment started within 1 hour of presentation
Sepsis 6:
- Take lactate, blood cultures, urine output
- Give oxygen, broad spectrum empirical antibiotics and IV fluids
What is neutropenic sepsis?
It is sepsis in a patient with a low neutrophil count of less than 1 x 10^9/L.
Which medications can cause neutropenia and therefore risk of neutropenic sepsis?
Chemotherapy
Clozapine
Hydroxychloroquine, Methotrexate and Sulfasalazine (used in RA)
Carbimazole - (hyperthyroidism)
Infliximab and Rituximab
Quinine (malaria)
When should you suspect neutropenic sepsis?
Low threshold for suspicion if taking immunosuppressants
Treat any temperature above 38C as neutropenic sepsis in these patients until proven otherwise.
They are at high risk of death from sepsis as their immune system cannot adequately fight the infection.
They need emergency admission and careful management.
Treatment of neutropenic sepsis
Immediate broad spectrum antibiotics
Don’t delay antibiotics waiting on investigation results in the immunosuppressed patients
