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Unit 9 > Week 1: Sepsis > Flashcards

Week 1: Sepsis Flashcards

1
Q

Define sepsis

A

A potentially life threatening condition caused by a dysregulated host response to infection, resulting in an acute systemic immune response.
Leads to fatal organ and tissue injury

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2
Q

Define septic shock

A

Sepsis, with a significant increase in mortality risk due to circulatory and cellular/metabolic abnormalities.
When blood pressure drops to a dangerously low level =<65mmHG and lactate remains => 2mmol/L after intervention and organ failure starts after an infection.

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3
Q

How common is septic shock?

A

Occurs in 30% of sepsis patients

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4
Q

What are the outcomes like for sepsis patients?

A

Mortality ranges from 10-30% for sepsis patient, higher 50% in septic shock.
Many survivors will suffer from hsopital readmission, early death, physical and neurocognitive dysfunction, mood disorders and low quality of life.

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5
Q

Why are sepsis death statistics important to public health?

A

Leading cause of death in hospitalised patients
Nearly 20% of all global deaths.

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6
Q

What are some risk factors for sepsis?

A

Extreme age
Male sex
Black patients
Chronic diseases - HIV and cancer
Immunosuppressed patients
Prior organ dysfunction
Delay in treatment and diagnosis
Recent surgery or invasive procedure
Pregnancy women, recent birth or miscarriage

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7
Q

What are the two classification or sepsis regarding aetiology?

A

Hospital acquired
Community acquired

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8
Q

What are the most common types of infection in sepsis?

A

Pneumonia
Intra-abdominal infections
Genitourinary infections (UTIs)

Follwed by endocarditis, meningitis and skin infections

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9
Q

How useful are blood cultures in sepsis diagnosis?

A

1/3 of blood cultures for sepsis patients will come back positive.

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10
Q

What are the most common gram-positive pathogens causing sepsis?

A

Staphylococcus aureus
Staphylococcus pneumonia

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11
Q

What are the most common gram negative pathogens that cause sepsis?

A

E.coli
Klebsiella spp
Pseudomonas aeruginosa

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12
Q

What type of pathogens are often responsible for causing sepsis?

A

79% bacterial
20% fungal
1% viral

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13
Q

What is the difference between microvascular and macrovascular?

A

Microvascular involves small vessels such as capillaries
Macrovascular involves large vessels such as arteries or veins.

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14
Q

Describe the pathophysiological process by which sepsis brings about vascular changes in the body.

A

Pathogen from infection. PAMPs recognised by PRRs triggering the inflammatory response.
This leads to tissue damage and necrotic cell death.
Release of DAMPs further activates leukocytes and promotes inflammation.
Microvascular changes include endothelial cell dysfunction, coagulation and complement activation.
Macrovascular changes include vasodilation and hypotension.

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15
Q

What are the pathophysiological consequences of the vascular changes in sepsis?

A

Microvascular and macrovascular changes result in vascular leak cuasing edema and intravascular volume depletion.
This reduces the oxygen supply to the tissue leading to increased glycolysis (hence higher lactate levels), leads to a build up a reactive oxygen species causing mitochondrial damage and organ damage.

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16
Q

How does sepsis affect the kidneys?

A

Can cause acute kidney injury due to:
Decreased urinary output
Uremia (waste products build up in blood)
Ileus (aversion to oral intake due to lack of emptying GIT)

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17
Q

How can liver failure be identified in sepsis?

A

Elevated liver enzymes

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18
Q

What makes up the sepsis 6?

A

Take blood cultures - Give IV antibiotics
Take lactate levels - Give oxygen
Take Urine Output - Give IV fluids

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19
Q

What is the purpose of taking blood cultures in the sepsis 6? What else might you also do to fit this purpose?

A

Peripheral blood sample to identify source of infection
May also take a urine dispstick, CSF sample or chest X-ray (pneumonia)

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20
Q

What is the example guidance of how to screen for sepsis?

A
  1. combined NEWS of 5+, single NEWS 3 or patient looks unwell
  2. Possibly an infection?
  3. one red flag present
  4. Or two amber flags and lactate level above 2mmols/L or Acute Kidney INJury
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21
Q

What is considered a red flag for sepsis?

A

Systolic BP below 90mmHg
Heart rate above 130 bpm
RR above 24 bpm
Require oxygen
Non-blanching rash
Not passed urine in the last 18hours
Urine output less than 0.5ml/kg/hr
Lactate => 2mmol/L
Chemotherapy within 6 weeks

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22
Q

How soon after sepsis diagnosis should treatment begin?

A

Within 1 hour

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23
Q

What is the qSOFA screening tool used for Sepsis?

A

Used to help diagnose a patient with sepsis
If two of the three are present suggests sepsis
1. Respiratory rate of 22/min or above
2. Altered mental status (glasgow coma of less than 15)
3. Systolic BP of 100mgHg or less

24
Q

What screening tool is recommended by NHS England for sepsis?

A

NEWs score
Lactate levels

25
Give an indication of how problematic sepsis is in the UK?
5 people die every hour in the UK from sepsis -45,000 deaths per year 27% of ICU emissions 1% of the NHS budget
26
Using the screening systems, a patient is identified as requiring screening for sepsis if....
1. Look unwell or someone is worried they are detriorating 2.Had recent chemotherapy 3. Has a NEWS2 score of five and above 4.Patient is at risk of neutropenia 5.Evidence of organ dysfunction 6. A recent infection/injury
27
What are the different screening tools that may be used for sepsis?
SOFA qSOFA SIRS NEWS2 MEWS
28
What is included in the SOFA score when screening for sepsis?
Cardiovascular system - blood pressure and dopamine Respiratory system - Partial pressure of oxygen Liver - billirubin levels in blood CNS - GCS REnal - serum creatine measured and urine output levels
29
What is included in the SIRS tool when screening for sepsis?
SIRS is defined as when two or more of the following are present in the patient -abnormal temperature -abnormal heart rate -abnormal respiratory rate - new confusion or drowsiness - abnormal WBC count - elevated blood glucose
30
What is the normal respiratory rate?
12-16 bpm
31
What is the normal blood glucose level?
4-7mmol/L
32
What is the normal white blood cell count?
4-11x10^9/L
33
On the NEWS Score what is considered a normal measurement?
Respiration rate:12-20 SpO2: over 96 Systolic BP = 111-219 Pulse = 51-90 Temperature= 36.1 to 38
34
What is the difference between type 1 and type 2 respiratory failure?
Type 1: hypoxemic - not enough oxygen Type 2: Hypercapnia - too much carbon dioxide
35
What variables does the MEWS score include?
Respiratory rate Heart rate Systolic blood pressure Temperature Hourly urine for two hours
36
What is the purpose of red flag sepsis?
Not a formal diagnostic tool Bedside tool which suggest the patient is likley to have some level of organ dysfunction Warns that s sepsis screening tool should be used
37
What is meant by the golden hour is sepsis screening?
Quality standard is to treat all sepsis patients within one hour of suspected sepsis
38
What should be assessed in everyone with suspected sepsis?
Temperature Heart rate Respiratory Rate Level of consciousness Oxygen saturation Mottled skin/cyanosis Non-blanching rash or breach of skin Frequency and amount of urination
39
What are the three key processes in the pathology of sepsis?
Vasodilation Capillary leak Blood clotting
40
What is the process behind vasodilation in sepsis?
H2 activates endothelial cells lining blood vessels Release NO causing dilation
41
What is the processes behind capillary leak in sepsis?
Inflammation - vasodilation adn increased permeability Leads to accumulation of fluid in the tissues Loss of fluid from blood stream leads to low blood pressures Fluid in lungs can impair breathing and oxygen exchange Lead to hypovolemic shock
42
What is the process behind blood clotting in sepsis?
Cytokines activate clotting cascade to limit infection Damaged endothelial cells can also lead to clot formation
43
What are the main pathological processes in sepsis ?
Blood pressure drops, heart rate increases to compensate. Poor perfusion to tissue, cells switch to anaerobic metabolism and generate lactic acid Build up of lactic acid causes lactic acidosis and a drop in pH making the body more acidic. Blood flow to essentail organs decreases, inlcuding kidneys No longer excrete H+ ions and reabsorbed HCO3- to balance pH Impaired liver metabolsim, acid not elimiated from body remains acidic.
44
What is multiple organ dysfunction syndrome?
Multiple organs fail due to impaired blood flow and function
45
What are the key clinical presentations of sepsis?
Fever or hypothermia Tachycardia Tachypnea Altered Mental Status Hypotension - result in cold clammy skin and reduced urine output
46
What are the common reasons why blood cultures of septic patients are negative?
Have antibiotics before blood cultures are taken Causative microorganism have no or limited proliferation in conventional blood cultures Diagnosis of organism requires special media or cell cultures conditions
47
What is the laboratory process of diagnosing sepsis?
Blood cultures are taken and cultured in aerobic or anaerobic conditions Microorganisms present metabolise nutriens in culture releasing CO2 which changes a dye in the bottom of the container This change can be detected by a sensor This indicates a microrganism has grown and can be taken for further diagnostic tests
48
What are the limitations of blood cultures as a method of sepsis diagnosis?
Delays in the transport of sample - faults e.g dropped Method of collection can be painful If taken after antibiotics may be less accurate Some organisms fail to grow in blood culture Hard to get the necessary volume or blood. Slow process before diagnosis
49
What is the most common microorganism causing sepsis in hospitals?
1. E.coli 2. Staphylococcus aureus 3.Streptococcus spp 4. Klebsiella spp
50
What is the most common microorganism causing sepsis in the community?
Staphylococcus aureus Enterococcus spp Candida spp E.coli
51
How affective is the Sepsis 6 in the treatment of sepsis?
If given within an hour of suspected sepsis can reduce mortality risk by almost 50%.
52
Identify
E.coli Gram negative (pink) Bacillus
53
Identify
Neisseria meningitidis Gram negative (pink) Diplococci
54
Identify
Staphyloccus aureus Gram positive (purple) Clumps of cocci
55
Identify
Streptococcus pneumonia Gram positive (purple) Cocci lancet shaped typically in pairs
56
Identify
Group B strep Gram positive (purple) Cocci typically in chains

Unit 9 (15 decks)

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