Sepsis Flashcards
(25 cards)
Aerobic vs anerobic respiration
Aerobic:
Sufficient ATP for cell to function and survive
Waste products – water and CO2
Anaerobic respiration produces:
Much less ATP
Cell dysfunction or death
Waste products – water, CO2 and Lactic acid
How to calculate blood pressure
Blood pressure = Cardiac Output (CO) x Peripheral Resistance (PR)
compensatory mechanisms for low bp
If a drop in B.P. is detected the body will try to bring it back to normal by altering CO (^HR) and PR (vasoconstriction)
SPECIFIC (Adaptive) IMMUNITY
Specific Antibodies
NON SPECIFIC (Innate)IMMUNITY
White blood cells (leukocytes), lymphocytes, complement
PHYSICAL / CHEMICAL BARRIER
Skin, Mucosa, Tonsils, Sweat, Tears
what causes inflammation?
the release of cytokines (chemicals released by the immune system that have an affect on other cells)
- Cytokines include:
- Histamine from mast cells - powerful vasodilator
- Nitric oxide – powerful vasodilator
Tumour Necrosis Factor, Interleukin1 and many others
Vasoldilation
- Also triggers change in core temperature – pyrexia or
hypothermia
Describe the process of sepsis
In Sepsis release of pro-inflammatory cytokines systemically (throughout the body) – which cause:
Systemic Vasodilation:
- drop in Peripheral Vasc. Resistance = drop in B.P.
- Compensatory mechanisms fail (Angtiotension II &
Noradrenaline)
- Causes blood vessels to become leaky
- Causes widespread oedema
- Fluid from oedema comes from systemic circulation
= relative hypovolaemia
Drop in B.P. (if not managed) causes
Anaerobic respiration from hypoxaemia -> Mitochonrial dysfunction
Lactic acid production = Metabolic Acidosis
Metabolic Acidosis – leads to cell death and further inflammatory reaction
A-E assessment of sepsis pt
sepsis risk assesment
A- make sure airway is patent
B- 21 – 24 = Moderate risk
>24 = High risk
Or new need for >40% oxygen to maintain SaO2 more than 92% = High risk
C- HR
91 – 130 = Moderate risk
>131 = High risk
Systolic B.P.
91 – 100 = Moderate risk
<90mmHg = High Risk
Not passed urine in past 12 – 18 hours = Moderate risk
Not passed urine > 18hrs = High risk
D- GCS< 15 (of new onset)
E/F -
Raised white cell count
Temp - Pyrexia>38C or Hypothermia <36 C = Moderate Risk
Mottled / ashen appearance / non blanching rash = High Risk
Signs of infection – redness / swelling / discharge
Cyanosis = High Risk
What groups are at high risk of sepsis
- name at least 3
Infants (under 1 year)
Elderly (over 75 years)
Impaired immune system:
- Cancer patients – active treatment
- Immuno-therapy – organ transplant or rheumatoid
arthritis
AIDS
Diabetes Mellitis
Recent surgery (less than 6 weeks)
Pregnancy, recent birth / termination / miscarriage (within 6 weeks)
Any breach of the skin
IV drug users
Indwelling lines or catheters
Describe the steps of the sepsis care bundle
Within first hour of arrival:
Measure lactate – remeasure if >2mmol/l
Obtain blood cultures before administering antibiotics
Administer broad spectrum antibiotics
Rapid administration 30ml/kg crystalloid fluid if hypotensive / Lactate > 4mmol/l
Give vasopressors if hypotensive during or after fluid – keep MAP >65mmHg
Priorities of care of the sepsis pt (A+B)
Airway Ensure patency (esp. GCS< 8)
Breathing
Maintain SaO2 > 94% (88-92% in COPD)
Consider if cause of infection is respiratory e.g.
pneumonia
May require ventilation
Priorities of care of the sepsis pt (c)
Maintain systolic B.P. >90mmHg
IV fluid resuscitation if hypotensive – 30ml/kg OR / AND Lactate >4mmol/litre
May require IV vasopressors if hypotensive despite fluids
Name and describe 4 vasopressors a pt might receive if they are still hypotensive despite IVT
Adrenaline – increases force of myocardial contraction, heart rate and peripheral resistance (vaso-constrict)
Noradrenaline – increases heart rate and increases peripheral resistance
Dopamine – increases heart rate and increases peripheral resistance
Dobutamine – stimulates beta 1 adrenergic receptors in heart – increases force of myocardial contraction and heart rate
Priorities of care of the sepsis pt (D)
Decreased GCS = risk to airway
Determine the cause of altered conscious state:
What are some causes of an altered mental state
BGL? Trauma? Stroke? Hypoxia? Hypotension? Toxins? Medication?
Priorities of care of the sepsis pt (E)
Rashes may not appear OR may be a very late sign
Log roll patient and expose all of patient – check skin folds, soles of feet
Monitor temperature – may be hyperthermic – BUT – could also be hypothermic
how does low bp relate to a build up of waste products and associated complications
low perfusion -> anaerobic respiration -> increased buildup of waste products -> low perfusion also inhibits waste removal and lactic acid starts to build up in the kidneys -> AKI and acidosis
Sepsis causes _____ acidosis
metabolic
due to the build-up of lactic acid
what requirements are needed of the
- blood
- vessels
- heart
to maintain Bp and homeostasis
- blood: enough volume, needs to have the right components
- vessels: intact, sight size
- heart: contraction, rate
mast cell purpose
trigger inflammation by releasing histamine, heparin
What is the normal range for lactate
<2mmol/L
why do you not give vasopressor infusions via a peripheral line?
(typically given through a central line)
Vasopressors cause vasoconstriction, if an IV infusion is running over an extended period of time this can lead to ischemia
