S3) Acute Sepsis in the Emergency Department Flashcards Preview

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Flashcards in S3) Acute Sepsis in the Emergency Department Deck (19)
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1

What is sepsis?

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

2

What is septic shock?

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

3

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- Septicaemia is generalised sepsis (outdated clinical term)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

4

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

5

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

6

Identify 5 red flags for sepsis

- Patient is unresponsive/confused

- Non-blanching rash

- HR > 130 bpm

- RR > 25 bpm

- Systolic BP < 90 mmHg

7

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

Immediately:

- Inform senior doctor for review

- Send urgent investigations

- Complete Sepsis Six Bundle

8

Identify 7 urgent investigations

- FBC

- Blood gases

- Blood sugar

- Urea and Electrolytes

- Liver Function Tests

- C-Reactive protein (CRP)

- Other microbiology samples (CSF, urine, etc)

9

What is the Sepsis 6 Bundle?

- Give:

I. Oxygen

II. Antibiotics 

III. Fluid challenge

- Take/measure:

I. Blood cultures

II. Lactate

III. Urine output

10

How does one confirm the diagnosis of acute sepsis?

- Blood culture

- PCR of blood

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

11

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

12

Identify 5 life-threatening complications of acute sepsis

- Irreversible hypotension

- Respiratory failure

- Acute kidney injury 

- Raised intracranial pressure

- Ischaemic necrosis of digits/hands/feet

13

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

14

Which pathogen causes meningoccocal disease?

Neisseria meningitidis

15

How does meningococcal disease spread?

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

16

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

17

Where are the different serogroups for meningitis derived from?

Different serogroups are based on the polysaccharide capsular antigen

18

Which is the most predominant meningitis serogroup in England?

1000 cases/yr mainly Group B

19

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