Sepsis Flashcards
(27 cards)
What is sepsis ?
A life threatening dysfunction in the organs that is caused by the deranged host responding to an infection. This can lead to organ failure and death
The body fighting against itself
Describe some signs of systematic inflammatory response syndrome (SIRS)
Temp - >38.3 or < 36
heart rate - >90bpm
Reps rate - >29/min
White blood count of
>1200 or < 4000
What is septic shock ?
This is a subset of sepsis which profounch circulatory, cellular and metabolic abnormalities are associated with greater risk of mortality
This is a medical emergency, serious disruptive shock, caused by uncontrolled, systemic, generlised inflammation
Describe the aetiology of sepsis
Any pathogen can enter the body and cause sepsis (E.g bacteria, virus, fungus)
Bacterial infections are most common when causing sepsis, the infection can come from any part of the body that is infected
The type of pathogens depend on the age, co-morbidities and geographic location
This can occur in anyone
Which groups are at higher risk of sepsis ?
Children under 1 or over 75’s
Immunocompromised due to illness
Breach of the skin barrier - wounds or burns
IV patients
Common pathogens in adults ?
Gram negative bacteria - E-coli, klebsilla
Gram positive bacteria - Enterococcus
Common pathogens in children/neonatal ?
Gram negative Bacilli
Group B streptococci
Explain the inflammatory response
Macrophages recognise pathogens and bind to then at the receptor on the membranes, this binding activates the immune cells to secrete inflammatory cytokines
Damaged cell release Histamine and Prostaglandins
These then recruit Leukocytes and Platelets from the blood to. The site of infection to eradicate it and have a clotting effect
These cause vasodilation and vascular permeability, causing fluid to spill over into the interstitial space
What are innate immune cells ?
White blood cells (Neutophils + Monocytes) notice pathogens and activate the release of inflammatory medications and Cytokines
What is the compliment system ?
Activation of the immune cells which help to fight infection causing more endothelial activation. These continue to produce the inflammatory meditators
What is the coagulation system ?
Activation of plasma cells lead to blood clotting
In sever infection the coagulation system becomes deranged and multiple clotting factors can occur and cause intravascular coagulation
What are endothelial cells ?
These contribute to vascular permeability casing fluid to cross into the interitual space. Endothelial dysfunction happens after cascade of immunology process
What are the clinical signs of infection ?
Swelling
Erythmia (redness)
Pain
Lymphadenopathy
Purulent (pus)
What are the system signs of infection ?
Hyperthermia
Fatigue/weakness
Headache
Leukocytosis ( increase in white blood cells)
Elevated Erythrocyte sedimentation rate (non-specific measurement of inflammation)
Clinical features in adults
An infection + two fo the following:
Resp rate > 20/min
Heart rate > 90
White cell count <4 or >12
Temp <38 or >38.3
Clinical features in children
Bulging fontanelle
A non-blanching rash
Decrease urine output
Reduced feeding/appetite
Hypotension
Hypoxia
Explain the pathophysiology of clinical features of sepsis
Body redirects blood to vital organs because of the reduced circulatory volumes
Vasoconstriction happens peripherally meaning that there’s a prelonged capillary refill time (CRT) mottled skin and cool peripherals
As sepsis progresses this means that there is not enough tissue perfusion meaning that the body isn’t receiving enough oxygen = hypoxia
This then causes production of lactic acid which is known as metabolic acidosis
Respiratory system compensates for the metabolic acidosis and increased the respiratory rate >20
The lack of perfusion results in organ dysfunction
Management of sepsis in CYP patients
- Administer high flow oxygen
- Gain IV access
- Give broad range IV (Cefotaxime - 50mg/kg)
- Supply fluids rapidly (0.9% NaCl 20ml/kg)
- Adrenaline infusion (0.3%mg/kg in 50ml of 5% glucose)
- Involve senior staff
Management of sepsis in adults
- Oxygen to achieve >98%
- IV fluids (>500ml in 1 hour)
- Blood cultures
- IV antibiotics
- measure lactate levels
- Asses output (consider catheter)
Describe the management of sepsis
Broad spectrum antibiotics (Amoxicillin - adults, Ceftaxime - CYP)
These are effective against gram positive and gram negative bacteria
Bloods taken to send to microbiology for gram specific testing for more effective antibiotics
What is the mode of action for antibiotics ?
Inhibits cell wall synthesis
Inhibits protein synthesis
Inhibitors of nucleic acid synthesis
What are Beta-Lactam antibiotics ?
Amoxicillin and Cefotaxime
Inhibiting bacterial cell wall synthesis making the bacteria cell useless and easier to eradicate
This antibiotic is given through IV
Side effects of Beta-lactum antibiotics ?
Rash
Itching
Hives
Fever
Vomiting
Stomach ache
Headache
Diarrhoea
What is inotropic therapy for sepsis ?
For people who done respond well to fluid resuscitation may require this treatment
Adrenaline recommended for children
Dobutamine for adults - increases the cardiac contractability and heart rate
A delay in administering this treatment increases the risk of mortality
