What is the SIRS criteria? (AV definition)
- Temp <36 or >38
- HR > 90
- RR > 20
- BP <90
Define sepsis?
A lifethreatening organ dysfunction caused by a dysregulated host response to an infection
What is the pathophysiology of sepsis?
- activation of WBC (nitrous oxide and other enzymes) and WBC recruitment
- Systemic Vascular Dilation (Vasodilation)
- Decreased SVR (CO x SVR = BP)
- Increased vessel permeability (leakiness) as (usually interstitial infection)
- Fluid loss to extravascular space - impaired tissue oxygenation
- Further damage to blood vessels due to lactic acid and other enzymes realised by WWBC
- Coagulation factors are over extended, unable to clot bleeding vessels and some clots break into blood stream (clotting with simultaneous active bleeding) - DIC
- ARDS - highly vascular lung tissue (with many blood vessels oxygenation) secandary to diffusion due to damaged blood vessels as above
- MODS
https://www.khanacademy.org/science/health-and-medicine/circulatory-system-diseases/shock/v/sepsis-sirs-mods
What is the prehospital management of sepsis? (Recite AV CPG)
https://cpg.ambulance.vic.gov.au/#/tabs/tab-0/info
What are the signs and symptoms of meningococcal disease in older children + adults?
- fever
- HA
- LOA
- neck stiffness
- photophobia
- N/V/D
- aching or sore muscles
- painful or swollen joints
- difficulty walking
- general malaise
- moaning, unintelligable speech
- drowsiness or confusion
- collapse
- reash of red or purple pin prick spots of larger bruises
What is the pathophysiology of meningococcal septicaemia
the complex physiology of meningococcal sepsis is largely explained by four basic processes affecting the microvasculature
1. increased vascular permeability
2. pathological vasoconstriction and vasodilation
3. loss of thromboresistance and intravascular coagulation
4. profound myocardial dysfucntion
What are the signs and symptoms of meningococcal septicaemia (infants & young childred)
- fever
- refusing to feed
- irritability, fretfulness
- grunting or moaning
- extreme tiredness or floppiness
- dislike of being handled
- N+V
- diarrhoea
- photophobia
- drowsiness
- convulsions/twitching
- rash or red or purple pin prick spots or larger bruises
What is the prehospital management of Meningococcal Septicaemia for adults?
https://cpg.ambulance.vic.gov.au/#/tabs/tab-0/image-viewer
What is the prehospital management of Meningococcal Septicaemia for paeds?
https://cpg.ambulance.vic.gov.au/#/tabs/tab-0/info
How do you calculate the cephtriaxone dose for paeds without a calculator?
What are the indications of cephtriaxone?
- suspected meningococcal septicaemia
- Severe sepsis (consult only)
What is septic shock?
- a subset of sepsis in which particularly profound circulatory, cellular and metabolic abnormalities are associated with greater risk of mortality then with sepsis alone
Who is at risk of meningococcal?
- Infants and young children under the age of four
- ATSI people aged 2 months to 19 years
- Teenagers and young adults aged 15 to 19 years old
- Teenagers and young adults aged 15 to 24 years living together in close quarters, such as dormitories and military barracks
- People with medical conditions that increase their risk of invasive meningococcal disease
- People living with patients who have meningococcal disease
- Teenagers and young adults aged 15 to 24 years who are exposed to cigarette smoke
- Travellers to countries with high rates of meningococcal disease
How is meningococcal spread?
- it spreads in close contact with each other for a long time - e.g. kissing intimately or living in the same household
- the bacteria can only live outside of the body for a few seconds, so you cant catch meningococcal disease from casual contact or from the environment.
- The bacteria do not spread easily from sharing food or drinks
- between 10-20% of the population carry the bacteria in their nose or throat without showing any signs of illness
What are the complications of meningococcal septicaemia?
- Septicaemic shock
- DIC
- Grossly septic/ischaemic limbs requiring amputation
What are the contraindications for cephtriaxone?
- allergy to cephalosporin antibiotics
What is the regular cephtriaxone dose for paeds?
50mg/kg (max 1g)
What is shock?
A state of cellular and tissue hypoxia due to either
- reduced oxygen delivery
- increased oxygen consumption
- inadequate oxygen utilisation
- or a combination of these processes
What are the 4 main types of shock?
- Cardiogenic (MI/failure)
- hypovolaemic
- Obstructive (blockage of fluid)
- Distributive (infection/anaphylactic/neurogenic)
What are the Stages of shock?
- Compensated Stage
- Progressive stage
- irreversible stage
What is meningococcal septicaemia?
- the rash occurs when the bacteria multiply in the blood vessels, and release toxins or poisons. These samage the blood vessels, so the blood can leak through into the tissues underneath the skin. It can start off either as a pink rash, or as a tiny red or purple blood spots, like pin pricks, anywhere on the body - which rapidly spread into purple blotches or bruises. the patient can literally bleed to death if not treated in time
What is meningococcal septicaemia?
- the rash occurs when the bacteria multiply in the blood vessels, and release toxins or poisons. These samage the blood vessels, so the blood can leak through into the tissues underneath the skin. It can start off either as a pink rash, or as a tiny red or purple blood spots, like pin pricks, anywhere on the body - which rapidly spread into purple blotches or bruises. the patient can literally bleed to death if not treated in time
