S3) Acute Sepsis in the Emergency Department Flashcards Preview

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What is sepsis?

Sepsis is life-threatening organ dysfunction due to dysregulated host response to infection


What is septic shock?

Septic shock is persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation


The terms sepsis, bacteraemia and septicaemia are not interchangeable.

Distinguish between them

- Bacteraemia is the presence of bacteria in the blood 

- Septicaemia is generalised sepsis (outdated clinical term)

- Sepsis is a life-threatening response to infection


What is an Early Warning Score?

An early warning score (EWS) is a guide used by medical services to quickly determine the degree of illness of a patient


How do we recognise sepsis?

- Patients look sick or have raised EWS (3/more)

- Clinical suspicion of infection e.g. pneumonia, UTI, meningitis, etc

- Red Flag(s) e.g. high RR, low BP, unresponsive


Identify 5 red flags for sepsis

- Patient is unresponsive/confused

- Non-blanching rash

- HR > 130 bpm

- RR > 25 bpm

- Systolic BP < 90 mmHg


How does one react to a patient with Red Flag Sepsis?


- Inform senior doctor for review

- Send urgent investigations

- Complete Sepsis Six Bundle


Identify 7 urgent investigations


- Blood gases

- Blood sugar

- Urea and Electrolytes

- Liver Function Tests

- C-Reactive protein (CRP)

- Other microbiology samples (CSF, urine, etc)


What is the Sepsis 6 Bundle?

- Give:

I. Oxygen

II. Antibiotics 

III. Fluid challenge

- Take/measure:

I. Blood cultures

II. Lactate

III. Urine output


How does one confirm the diagnosis of acute sepsis?

- Blood culture

- PCR of blood

- Microscopy, culture & PCR of CSF (through lumbar puncture)


A lumbar puncture is only performed after checking contraindications. 

Describe how CSF is examined

- Look at appearance (turbidity and colour)

- Microscopy of leukocytes and erythrocytes 

- Gram stain performed

- Referral for PCR


Identify 5 life-threatening complications of acute sepsis

- Irreversible hypotension

- Respiratory failure

- Acute kidney injury 

- Raised intracranial pressure

- Ischaemic necrosis of digits/hands/feet


What is meningococcal disease?

- Meningococcal disease is a bacterial form of meningitis, a serious infection of the meninges that affects the brain membrane

- It presents with a purpuric rash, light sensitivity, fever and neck stiffness


Which pathogen causes meningoccocal disease?

Neisseria meningitidis


How does meningococcal disease spread?

Spread by direct contact with respiratory secretions e.g. aerosols, nasopharyngeal secretions


Describe the properties of the meningococcus bacteria – Neisseria meningitidis

- Gram-negative diplococcus

- Numerous serogroups e.g. A, B, C, W-135

- Outer membrane acts as an endotoxin

- Most people are harmlessly colonised


Where are the different serogroups for meningitis derived from?

Different serogroups are based on the polysaccharide capsular antigen


Which is the most predominant meningitis serogroup in England?

1000 cases/yr mainly Group B


What are the preventions for meningococcal disease?

1. Prevention: Vaccination

I. Menningococcal C conjugate vaccine

II. ACWY vaccines

III. Serogroup B vaccines

2. Prevention: Antibiotic Prophylaxis