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RB Y2 CLASP - Sepsis > SEPSIS > Flashcards

Flashcards in SEPSIS Deck (27):
1

define colonsation 

the presence of a microbe in the human body without an inflammatory response 

2

define infection 

inflammation due to a microbe 

3

define bacteraemia 

the presence of viable bacteria in the blood 

4

define sepsis 

life-threatening organ dysfunction caused by a dysregulated host response to infection

5

define septic shock 

  • Subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality.
  • There must have been adequate attempts at resuscitation

6

name 4 risk factors for sepsis 

  • <1 year and >75 years 
  • recent trauma/surgery or invasive procedure 
  • impaired immunity due to illness (eg DM) or drugs (eg long term chemo or IS)
  • any breach of skin integrity ( eg cut, burn, blister, skin infection), indwelling lines and catheters

7

correction of hypotension 

  • fluid resuscitation 
  • if required inotropes and vasoconstrictors can be used

8

use of inotropes 

  • eg nor/adrenaline 
  • cause vasoconstriction ± increase myocardial contractility 
  • indicated when there is persistent hypotensiondespite optimized fluid resuscitation/euvolaemia restored 

9

shock liver 

  • acute liver injury caused by hypoperfusion 
  • can cause transaminitis (grossly elevated ALT/AST in blood stream) and jaundice due to hepatocyte injury

10

CNS features of sepsis 

  • delirium/acute confusional state due to diffuse cerebral hypoperfusion/dysfunction 
  • drowsiness and decreased conscious level 

11

how can lactic acidosis occur in sepsis 

  • type A (due to tissue hypoxia) 
  • diffuse tissue hypoxia results in anaerobic metabolism (lactic acid is the end product of anaerboic metabolism of glucose)

12

what effect does metabolic acidosis have on CV stability 

worsens it 

13

haematological effects of sepsis 

  • disseminated intravascular coagulation: small clots form throughout the blood stream blocking small blood vessels 
  • increased clotting decreases platelets and clotting factors needed to control bleeding 

14

evidence of DIC

  • low platelets 
  • prolonged APTT/PT 
  • low fibrinogen 

15

SIRS criteria 

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16

what else can cause SIRS 

NO INFECTION - NOT SEPSIS 

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17

Can sepsis be caused by viruses 

yes 

18

qSOFA score 

  • identifies high risk patients for in-hospital mortality with suspected infection 
  • ≥2 qSOFA score and the likelihood of infection is assocated with a greater risk of death/prolonged ITU stay 

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19

GCS 

<14 needed for qSOFA 

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20

NEWS score for sepsis 

≥5 and indication of infeciton = SEPSIS 

21

SEPSIS 6 BUNDLE 

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22

blood cultures - before or after ABx, and how many 

  • blood cultures then IV ABx 
  • sample area of infection in addition to blood cultures eg stool, urine, tissue, wound etc 
  • one blood culture (set of 2) is enough 

23

how many blood cultures for suspected endocarditis 

3 sets of 2, spread over one hour 

then ABx 

24

pathology of hypotension in sepsis 

  • bacteria produce toxins which stimulate the immune system to produce cytokines 
  • these increase NO production in vascular smooth muscle which is a potent vasodilator 
  • vasodilation - fall in TPR, fall in BP 
  • endothelial dysfunction and capillary leak leads to decreased intravascular volume 

25

consequences of hypotension 

  • results in tissue hypoperfusion 
  • hypoxia and organ dysfunction 
  • hypoxia leads to anaerobic metabolism, which produces lactic acid as a by product 
  • metabolic acidosis with raised anion gap
  • deterimental effects 

26

fluid in SEPSIS 6 

500ml saline 0.9% STAT (immediately) 

27

serum lactate level 

  • normal <1.8 mmol/L 
  • elevation suggests hypoperfusion/hypoxia 
  • can be used to assess response following treatment