intra-abdominal sepsis and infection Flashcards
(22 cards)
what is bacteraemia ?
The presence of viable bacteria in the blood
what is sepsis ?
The systemic inflammatory response to infection
what three things make it hard to recognise/diagnose infection?
- abnormal host response
- abnormal microbe response
- site of infection
what are the symptoms and signs of local infection?
Pain
Tenderness
Guarding
Blood PR in some
what are the symptoms and signs of systemic infection?
fever, rigors and chills nausea or vomiting constipation or diarrhoea malaise/ anorexia
SIRS is defined as having ≥2 of the following:
- pulse > 90beats/min
- respiratory rate > 20
- WCC > 12,000 or 10 % immature neutrophils
- temp > 38 or
sepsis is ____ with a presumed or confirmed _____
SIRS, infection
what is severe sepsis ?
sepsis with signs of at least one acute organ dysfunction
- renal
- respiratory
- hepatic
- haematological
- CNS
- unexplained metabolic acidosis
what is septic shock ?
severe sepsis with hypotension refractory to adequate volume resuscitation
how is infection diagnosed
blood cuulture, stool, urine, wound, tissue culture
WCC
CRP
platelets, clotting
what are the Common community Bacterial Causes of Infection leading to septic syndrome
E.COLI (urine, abdomen) - NOT from gastroenteritis
S.pneumoniae (respiratory)
S. aureus (usually MSSA - skin)
what are the Common hospital Bacterial Causes of Infection leading to septic syndrome
E.coli (catheter related or abdomen)
S.aureus (may be MRSA- line or wound related)
Coagulase Negative Staphylococci (line/prosthesis related)
Enterococci (urine, wound, line)
Klebsiella spp (urine, wound)
Pseudomonas spp,.
which sites of infection are more likely to lead to bacteraemia?
. complicated urinary tract, pneumonia, endocarditis, meningitis, deep abscess
which organisms more liekly lead to bacteraemia?
salmonella typhi
people with intra-abdominal sepsis or infection Need _____ management and _____ management
Need antibiotic management and supportive management
what is the supportive treatment?
Fluids Analgesia Need for surgery: exploration, incision-excision and drainage (in abscess) VTE prophylaxis Oxygen Control of electrolyte balance Need for transfusion
after giving antibiotics you should review at ____ hours
48
what should be done at 48 hours empirical therapy - antibiotics
should either
- stop
- IV/Oral switch
- change to narrow spectrum
- continue and review after a further 24 hours
what is the sepsis 6 bundle treatment for sepsis?
- high flow oxygen
- start IV fluid resus
- take blood cultures
- give IV antibiotics
- measure lactatae and FBC
- monitor accurately hourly urine output
what does increased lactate PRODUCTION signify?
Tissue hypoperfusion
Tissue dysoxia
what does reduces lactate METABOLISM signify?
hepatic and renal problems
_ is bad, >_ is very bad
2 is bad, >4 is very bad
