INFECTIOUS DISEASES: Sepsis Flashcards Preview

Year 3 Medicine Block > INFECTIOUS DISEASES: Sepsis > Flashcards

Flashcards in INFECTIOUS DISEASES: Sepsis Deck (15)
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1
Q
A
2
Q

Define sepsis

A

Life threatening organ dysfunction caused by a dysregulated host response to an infection

3
Q

Define septic shock

A

Subset of sepsis with profound circulatory, cellular and metabolic abnormalities. Associated with greater risk of mortality than sepsis alone

Z2F: this is when arterial BP drops resulting in organ hypo-perfusion

4
Q

How can septic shock be measured?

A

Systolic BP less than 90 despite fluid resuscitation
HYPERlactaemia - where lactate is >4 mmol/l

5
Q

Pathophysiology of sepsis?

A

3 main parts: Cytokine - Coag - Lactate

Cytokines:

1) Pathogens recognised by macrophages, lymphocytes and mast cells
2) Cells release cytokines - cytokines activates other parts of immune system.
3) activation causes vasodilation
4) cytokines make endothelial lining of BV more permeable = so fluid leaks out —> get oedema and reduced intravascular vol.
5) oedema around BV means less O2 can reach tissues

COag:

6) Coag system is activated too!
7) fibrin deposits throughout circulation = also reducing tissue perfusion.
8) Platelets and clotting factors are used up to make clots —> causes thrombocytopenia, haemorrhages (so can’t make any other clots or stop bleeding). = DIC.

Lactate:
9) Get anaerobic resp as no O2 reaching tissues = so blood lactate rises. (as lactate is waste prod of anaerobic resp).

6
Q

SEPSIS mnemonic

A

Slurred speech or confusion
Extreme shivering or muscle pain
Passing no urine (in 24hrs)
Severe breathlessness
I feel like I’m going to die
Skin mottled or discoloured

7
Q

RF for developing sepsis?

A

V young or old - under 1, over 75
Chronic conditions e.g. COPD, DM
Immunosuppressed - chemo, immunosuppressants, steroids
Surgery, trauma, burns
Pregnancy, permpartum (just before or after birth)
Indwelling medical devices - catheter, cannula

8
Q

Presentation of sepsis?

A

Scoring on NEWS.
What is involved?:
Temp, HR, RR, O2 sats, BP, consciousness level (AVPU)

9
Q

Signs of sepsis on examination?

A
  • Sources of infection - cellulitis, wound discharge, cough, dysuria
  • Non blanching rash
  • Mottled skin
  • Cyanosis
  • Arrythmia - new onset AF
10
Q

Investigations for sepsis?

A

FBC - Wcc, neutrophils
U&Es - renal function, AKI
LFTs - liver function, liver is potential source of infection
CRP - assess inflammation
Coag screen/clotting - DIC
Blood cultures - bacteraemia
Blood gas - lactate, pH, glucose

Also could do:

  • Urine dip and culture
  • CXR
  • CT scan abdo - suspect infection or abscess
  • Lumbar puncture - suspect meningism
11
Q

Management for sepsis

A

1) Assessed and treated within 1 hour of presentation
2) Perform sepsis 6:
Take blood lactate, take urine output, take blood cultures.
Give oxygen, broad spec abx, IV fluids
3) escalate - senior, HDU, ICU

12
Q

Define neutropenic sepsis

A

Sepsis in pt with low neutrophil count of less than 1 x10(9) L

13
Q

Causes of neutropenia in pts?

A

Anti- cancer chemo
Immunosupressants for RA - Hydroxychloroquine, Methotrexate, Sulfasalazine
Other immunosuppressants - Infliximab, Rituximab
Malaria treatment - Quinine
HyperThyroid treatment - Carbimazole

14
Q

Why is neutropenic sepsis so urgent to manage?

A

Pts do not have immune system to fight infection - so are at high risk of death. Need emergency admission and management

15
Q

Specific treatment for neutropenic sepsis

A

Immediate broad spec abx:
Piperacillin with tazobactam (tazocin)

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