sepsis

Question 1

what is sepsis

Answer 1

physiological response to infection characterised by inflammation and where immune system becomes disregulated. basically overwhelming immune response

Question 2

what characterises local infection

Answer 2

rubor, tumor, calor and dolor. caused by WBC profiliations, vasodilation and capillary leakage at the site of infection

Question 3

how does inflammation differ in sepsis

Answer 3

in sepsis local infection response happens throughout entire body. seen fallen BP and flushing

Question 4

describe all the symptoms of sepsis

Answer 4

A- airways - no specific affect unless infection arises from throat or neck but may be at risk of airways problems if unconscious
B- breathing- raised respiratory rate due to increased proteins leaking into lung tissue causing lung oedema
C- circulation- vasodilation causes capillary leakage and hypotension. to compensate heart beats faster causing tachycardia
D- disability -reudced blood flow to brain presented as confusion, drowsiness, slurred speech etc
E-exposure- high temperature due to response of hypothalamus to infection. may have hypothermia in elderly due to vasodilation especially in elderly

Question 5

method to help public recognise sepsis

Answer 5

S- slurred speech
E- extreme shivering or muscle pain
P- passing no urine (effect of hypotension on kidney)
S- server breathlessness
I- it feels like you’re going to die (hypoxia)
S- skin mottled or discoloured

Question 6

who is especially at risk from sepsis

Answer 6

very you (under 1 year), elderly/frail, pregnant/post party due to reduced immune system and patients with impaired immune system

Question 7

when to think sepsis

Answer 7

got early warning score, looks ill and has any signs of infection

Question 8

whats an early warning score (NEWS2)

Answer 8

1. resp rate
2. o2 sat
3. systolic BP
4. pulse rate (HR)
5. level of consciousness
6. temp these jobs are added together. the further the score is from the norm = shows spesis. must keep following it up. BUT does not exactly provide diagnosis. requires clinical analysis

Question 9

red flag sepsis- critter to identify patients who have high risk of deterioration with sepsis

Answer 9

AVPU changed from normal 
acute confusion 
resp rate > 25 per min 
needs oxygen 
heart rate > 130bpm 
systolic BO < 90 
not passed urine in last 18 hours 
rash 
recent chemotherapy

Question 10

how is sepsis managed

Answer 10

1. oxygen
2. take culture to show exactly whats causing infection so can give correct antibiotics
3. give generic antibiotics
4. fluids
5. take hb and lactate measure (lactate released when tissues become hypoxic)
6. monitor urine output

Question 11

list some additional investigations that can be done when sepsis is suspected

Answer 11

supportive;
blood count
blood sugar 
liver function test 
CRP 
coagulation study 
blood gas 

specific;
cerebrospinal fluid (meningitis)
throat swab
bottle for PCR

Question 12

what signs does cerebrospinal fluid show if infection is meningitis

Answer 12

low glucose and high protein, cloudy in colour due to WBV and then can use PCR to identify bacteria which would be meningococcus which is spread by aerosol and therefore very infective

Question 13

how to treat meningitis

Answer 13

antibiotics which cross blood brain barrier. Laos have vaccination for it and prophylaxis for those close to person to ensure they don’t become infected