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Infection Term 4 > 3- Sepsis > Flashcards

3- Sepsis Flashcards

1
Q

Define sepsis

A

Life threatening organ dysfunction due to a dysregulated host response to infection

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2
Q

Describe the mechanism of sepsis

A

when a microbe enters the body, host defence systems produce mediators to activate the immune system to limit spread of microbes

  • activation of inflammatory cascade leads to activation of coagulation and fibrin deposition
  • body responds to infection by injury to its own tissues/ organs
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3
Q

What 2 things does sepsis cause?

A
  • shock

- multiple organ failure and death

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4
Q

What is the MAIN cause of sepsis?

A

gram negative bacteria eg E. coli
-have lipopolysaccharides eg LPS
main cause of developing sepsis

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5
Q

How do gram negative bacteria cause sepsis?

A
  • their LPS activates macrophages and natural killer cells
  • macrophages and NK cells activate a positive feedback loop which AMPLIFIES immune response so that innate immune system can respond quickly and strongly to local infection
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6
Q

What are the 3 main steps of managing sepsis ( general)

A

1) Identify sepsis
2) Categorise sepsis
3) Initiate treatment

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7
Q

How do you categorise sepsis?
RHLRBV
Royal High Lilacs Robust Brew Venture

A

by the SOFA criteria
Sequential Organ Failure Assessment ( in ITU patients)
SOFA= suspected infection+ change in more than 2 of below from baseline:
1) RESP: pO2/ FiO2 ratio
2) HAEMATOLOGY: platelet count
3) LIVER: serum bilirubin
4) RENAL: serum creatinine eg urine output
5) BRAIN: Glasgow Coma Scale
6) CVS: hypotension
vasopressor requirement

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8
Q

What is SIRS?

Why is it no longer recommended?

A

Systemic Inflammatory Response Syndrome

  • certain abnormalities of vital signs and lab results
  • used previously to identify early sepsis

-no longer recommended because
poor sensitivity
poor specificity

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9
Q

How do you initiate treatment for sepsis? ie within 3 HOURS

MOAA

A

should complete within 3 hours

1) Measure lactate level
2) Obtain blood cultures prior to admin of antibiotics
3) Administer broad spectrum antibiotics
4) Administer 30 ml/kg crystalloid if
-hypotension
or
-lactate 4mmol/L or more

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10
Q

What treatment steps do you follow up within 6 HOURS

A

5) App vasopressors for hypotension that does not respond to initial fluid resuscitation
to maintain MAP> 65mmHg

6) if hypotension is persistent, re-assess volume status and tissue perfusion
7) Re-measure lactate if initial lactate is elevated

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11
Q

What is septic shock?

A
  • severe abnormalities of circulation and/or cellular metabolism
  • persistent hypotension
  • high mortality
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12
Q

What 2 processes are involved in sepsis?

A

Immune sytem

Coagulation cascade

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13
Q

What role does the immune response play in sepsis? ( 5 steps)

A

-activation of signalling cascade
-recruitment
-increased expression of cytokines
-causes acute inflammation
and stimulation of adaptive immunity

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14
Q

What vascular changes occur in sepsis?

A
  • vasodilation
  • vascular permeability
  • increased adhesion of WBC’s
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15
Q

What cellular events occur in sepsis?

A

cellular recruitment and activation of neutrophils (PMN’s)

-neutrophil migration to injury site and therefore vascular permeability increases

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16
Q

What happens overall from sepsis to arteries?

A
  • warm shock
  • arteries and arterioles dilate,
  • decreasing peripheral arterial resistance
  • cardiac output typically increases
17
Q

What is ABSOLUTE HYPOVOLAEMIA?

A
  • reduction in circulating volume relating to blood or plasma loss
  • blood volume is smaller
18
Q

What results from absolute hypovolaemia?

MAP= TPR X CO ( HR X SV)

A

-decrease in systemic vascular resistance
(remember MAP formula)

-thus decrease in BP

baroreceptors get activated and thus you get

COMPENSATORY TACHYCARDIA

19
Q

How do you get organ failure from sepsis?

A
  • poor capillary flow and capillary obstruction by micro thrombi
  • therefore decreased oxygen delivery
  • impaired CO2 and waste removal
  • decreased perfusion causes organ dysfunction
20
Q

How does decompensated shock occur?

A

-reduced circulating volume caused by capillary leakage
ie reduced venous return

therefore:

-reduced cardiac output
-reduced BP falls even FURTHER
-reduced flow to organs
typical features of shock appear

21
Q

Describe the effect of shock on the lungs?

A

-increased resp rate ie tachypnoea
-rapid breathing
-SOB ie dyspnoea
-surfactant dries out——–> stiffening of lungs——>ARDS
(diffusion in alveoli also decreases)

22
Q

What is ARDS?

A

Acute Respiratory Distress Syndrome

23
Q

How does sepsis affect tissues?

A

-you get anaerobic respiration in tissues
cells use pyruvate therefore lactic acid builds up
-decreased pH
-metabolic acidosis
-body responds by increasing resp rate

24
Q

How does sepsis affect the brain? (6)

A
  • confusion
  • raised blood sugar
  • increased gluconeogenesis and insulin resistance
  • inhibition of tissues’ ability to uptake glucose
  • caused by CRP; inflammation marker
  • Low blood volume; increased vascularisation ; can lower body temperature ( not always raise it)
25
Q

How does sepsis affect the clotting cascade?

A

-bacteria cause inflammatory response in cell
-activates complement system
-C5a is responsible for activation of TISSUE FACTOR
and expression of tissue factor on the surface of monocytes
-activation of tissue factor
-thus activation of clotting cascade
-fibrin deposits throughout the body

26
Q

How does systemic inflammation affect coagulation?

A

activates coagulation because of:

  • tissue factor-mediated thrombin generation
  • down-regulation of physiological anticoagulant mechanisms
  • inhibition of fibrinolysis
27
Q

How does sepsis cause purpura?

A

Purpura sepsis

  • DIC, disseminated intravascular coagulation and dermal vascular thrombosis cause haemorrhage infarction of skin
  • caused by septic shock

can also be because of HSP

28
Q

3 things which help you to recognise sepsis?

A
  • TEMPERATURE
  • HEART RATE
  • LOW BP
29
Q

NAME THE RED FLAGS OF SEPSIS

RASHRN3LR

A 
RESPONDS only to voice/ pain
ACUTE confusional state
SYSTOLIC BP< 90 mmHg 
HEART rate >130/minute
RESP rate> 25/minute
NEEDS Oxygen
NON-blanching rash, mottled, cyanotic 
NOT passed urine in last 18 hours 
LACTATE> 2mmol/L
RECENT chemo
30
Q

How does NEWS score help in sepsis detection?

ROTSPL

A

used to detect how severe a patient’s general illness state is
-high NEWS score gives a path to follow for treatment

Measures: 
Resp
O2 sats
Temp
Systolic BP
Pulse rate
Level of consciousness
31
Q

What would NEWS score of 5 indicate?

A

use clinical judgement and follow combined sepsis deterioration pathway
only problem is that sepsis causes very GENERIC symptoms

32
Q

What are the SEPSIS 6?

A
  • Give 3
  • Take 3

1) Give oxygen bc of hypoxia
2) Take cultures to identify infection
3) Give IV antiobiotics
4) Give IV fluids ( to treat hypovolaemia and hypotension)
5) Take lactate level ( to identify tissues in a hypoxic state)
6) Take urine output measurement ( to measure GFR and renal function

33
Q

What is the body’s response to microorganism?

A
  1. Microorganisms invade the body tissues
  2. Immune response activated
  3. provokes the activation of biochemical cytokines and mediators associated with an inflammatory response.
  4. Increased capillary permeability and vasodilation interrupt the body’s ability to provide adequate perfusion, oxygen, and nutrients to the tissues and cells.
  5. Proinflammatory and anti-inflammatory cytokines released during the inflammatory response and activates the coagulation system that forms clots whether or not there is bleeding.
  6. The imbalance of the inflammatory response and the clotting and fibrinolysis cascades are critical elements of the physiologic progression of sepsis in affected patients.
34
Q

Describe the quick SOFA score (qSOFA)

A

Resp rate of 22/min or greater
Altered mental state; GCS <15
Systolic blood pressure of 100mmHg or less

35
Q

Give 4 criteria used previously to measure SIRS

A

Temp<36 or >38
HR>90
RR>20 or pCO2<32 hyperventilation)
WBC count<4000 or WBC count>12,000 or bands>10%

36
Q

How was sepsis previously defined in relation to SIRS?

A

SIRS with infection

no longer used

Infection Term 4 (8 decks)

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