13. Sepsis Flashcards
What is Sepsis
a condition where the body launches a large immune response to an infection that causes systemic inflammation and affects the functioning of the organs of the body
Describe the pathophysiology of sepsis
recognised by macrophages, lymphocytes and mast cells
they release cytokines such as IL and TNF and also NO which cause vasodilation
Many of the cytokines cause endothelial lining of blood vessels to be more permeable and leakage occurs –> oedema
Define septic shock
when arterial BP drops and results in organ hypo-perfusion
leads to rise in blood lactate as the organs begin anaerobic respiration
Systolic BP less than 90 despite. fluid resuscitation
Hyperlactaemia (lactate greater than 4)
Severe sepsis is defined when sepsis is present and results in organ dysfunction; give some examples
- Hypoxia
- Oliguria
- Acute Kidney Injury
- Thrombocytopenia
- Coagulation dysfunction
- Hypotension
- Hyperlactaemia (> 2 mmol/L)
what are the risk factors for sepsis
Any condition that impacts the immune system or makes the patient more frail or prone to infection is a risk factor for developing sepsis:
- Very young or old patients (under 1 or over 75 years)
- Chronic conditions such as COPD and diabetes
- Chemotherapy, immunosuppressants or steroids
- Surgery or recent trauma or burns
- Pregnancy or peripartum
- Indwelling medical devices such as catheters or central lines
what is often the first sign of sepsis
tachypnoea (high RR)
how do elderly patients usually present
with confusion or drowsiness or simply “off legs”
NEWS is used to pick up on the signs of sepsis but name some other signs that could be present on examination
- Signs of potential sources such as cellulitis, discharge from a wound, cough or dysuria
- Non-blanching rash can indicate meningococcal septicaemia
- Reduced urine output
- Mottled skin
- Cyanosis
- Arrhythmias such as new onset atrial fibrillation
What blood tests would you carry out in suspected sepsis
- Full blood count to assess cell count including white cells and neutrophils
- U&Es to assess kidney function and for acute kidney injury
- LFTs to assess liver function and for possible source of infection
- CRP to assess inflammation
- Clotting to assess for disseminated intravascular coagulopathy (DIC)
- Blood cultures to assess for bacteraemia
- Blood gas to assess lactate, pH and glucose
apart from blood tests, what other investigations would you arrange to help locate the source of the infection in suspected sepsis
- Urine dipstick and culture
- Chest xray
- CT scan if intra-abdominal infection or abscess is suspected
- Lumbar puncture for meningitis or encephalitis
Patients should be assessed and treatment initiated within ____ of presenting with suspected sepsis and this involves performing the sepsis 6
1 hour
what is the sepsis 6
three tests:
- blood lactate
- Blood cultures
- Urine output
three treatments
- oxygen to maintain sats 94-98% (or 88-92% in COPD patients
- empirical broad spectrum antibiotics
- IV fluids
Lactate accumulates in the blood as a result of
anaerobic respiration which is the response to a lack of oxygen reaching the tissues
Why is confusion often a late sign of sepsis
the body tries to preserve oxygen to vital organs first
What is the maximum total volume of crystalloid fluid you should give a patient before referring to ICU for invasive circulatory support
500ml bolus to a maximum of 2L
