Sepsis Flashcards
What is sepsis? Where can it affect?
syndrome defined as life threatening organ dysfunction due to a dysregulated host response to infection
- immune system overreacts to an infection
sepsis < severe sepsis < septic shock
heart (septic cardiomyopathy) - reduced blood flow, hypoperfusion, depression of myocyte activity
brain - low BP, micro-clots, damage from inflammatory mediators
nervous system
kidneys - AKI
liver - increased gluconeogensis and glycogenolysis
lungs - respiratory distress syndrome
blood vessels - leakage, coagulation defects
What is septic shock?
sepsis with
- persisting hypotension requiring vasopressors to maintain mean arterial pressure (MAP) > 65mmHg
- serum lactate level >2mmol/L
despite fluid resuscitation
- typically given to raise blood pressure
sepsis > severe sepsis, septic shock
What is the pathphysiology of sepsis?
causative agents
- infection, trauma, shock
excessive inflammatory response
- pro-inflammatory cytokines and chemokine, ROS production, enzyme release
increased
- vascular permeability (due to vasodilation by BK, IL, NO, H), bacteria killing, peripheral resistance
tachycardia, tachypnoea, fever, leukocytosis, disseminated intravascular coagulation, hyper-coagulability
effects
- oedema, tissue damage, organ failure, leukcytopenia, susceptibility to infection, shutdown of neutrophilic and phagocytic responses
What are the risk factors for sepsis?
impaired immunity
- very young (<1 years), elderly (>75 years), chemotherapy, diabetes, those without a spleen, long term steroids, immunosuppressants, infections
- recent surgery, indwelling lines or catheters
- recent birth/miscarriage/termination
What are the common causative pathogens of sepsis?
adults
- staphylococcus aureus (+)
- streptococcus pyogenes (+)
- klebsiella spp (-)
- e.coli (-)
- pseudomonas aeruginosa (-)
children
- Group B strep (neonates) (+)
- strep pneumonia (+)
- pseudomonas aeruginosa (-)
- neisseria meningitidis (-)
- staphylococcus aureus (+)
What are sepsis symptoms in children?
breathing fast - tachypnoea
has a fit or convulsion
looks mottled, blueish or pale
rash that does not fade/blanch
lethargic or difficult to wake
feeling abnormally cold to touch
under 5s
- not feeding
- repeat vomiting
- making grunting noises
- dry nappy >12 hours
What are symptoms of sepsis?
S - slurred speech or confusion
E - extreme shivering or muscle
P - passing no urine in a day
S - severe breathlessness
I - it feels like you are going to die
S - skin mottled or discoloured (not always present/depends on type of sepsis)
skin can become necrotic
- as sepsis progresses, the red area coalesces and may become blue/black
= leading to amputation or disability
What are the signs/red flags of sepsis?
responds only to voice or pain/unresponsive
systolic blood pressure <90mmHg (or drop >40 from normal)
heart rate >130 beats per minute
respiratory rate >30 breaths per minute
needs oxygen to keep saturation >92%
non-blanching rash, mottled/ashen/cyanotic
not passed urine in the last 18 hours
urine output <0.5ml/kg/hr
lactate >2mmol/L
recent chemotherapy
What is a symptom that can be a sign of sepsis?
sore throat
- caused by Group A streptococcus
What is the NEWS2 score?
national early warning scores
- based on sepsis red flags
looks at
- respiratory rate
- oxygen saturation of blood
- use of oxygen and how much
- blood pressure
- pulse
- new changes to level of consciousness
- temperature
What is the SEPSIS 6?
IV antibiotics
- within an hour
- start with broad spectrum then narrow spectrum when cultures results are available
IV fluid bolus
- to raise blood pressure
provide oxygen
- to target >94% or 88-92% in COPD
cultures
- sputum, urine, wound swab, vascular access device
bloods
- FBC, clotting, U&Es, LFTs, CRP, lactate
monitor urine output
- consider indwelling catheter and fluid balance chart
