3.1 - Sepsis Flashcards
Definition of sepsis + septic shock
sepsis
Life-threatening organ dysfunction due to a dysregulated host response to infection
septic shock
Particularly profound circulatory, cellular + metabolic abnormalities substantially increase mortality
- Collection of physiological responses to infection
- Characterised by inflammation
- Reactions of immune system to infection becomes dysregulated
What are the 4 symptoms/signs of local infection
- Rubor
- Tumor
- Calor
- Dolor
this doesn’t mean that the patient has sepsis, but left untreated, it may get more severe – bacteria going into bloodstream ☞ bacteraemia
What is bacteraemia
When bacteria get into bloodstream. This may develop into sepsis.
What happens in sepsis
- Capillary leakage
- Excess neutrophils
- Excess vasodilation
- Amplification: excess cytokines etc amplify further inflammation downstream
- Leads to systemic inflammation
Effects of sepsis on organ systems (ABCDE)
- airways - nothing specific (unless infection arises from throat/neck). Later, if decreased consciousness, may lose ability to maintain airway
- breathing - tachypnoea. Lung oedema + decreased lung compliance (due to fluids + proteins leaking into interstitial tissues)
- circulation - hypotension + hypovolaemia (due to vasodilation + capillary leakage). Tachycardia + end-organ damage
- disability - reduced blood flow to brain (confusion, drowsiness, slurred speech, anxiety, reduced consciousness)
- exposure - high temp (due to hypothalamus releasing pyrogens). Hypothermia may present in elderly.
Who is particularly at risk of sepsis
- very young - under 1 y/o
- elderly - over 75 or frail
- pregnant or post-partum (within 6 weeks)
- immunocompromised due to illness or drugs
When should a patient be screened for sepsis
in context of presumed or confirmed infection
- HCP worried about patient
- NEWS2 above 5
- Risk of neutropenia
- Evidence of organ dysfunction (eg lactate 2mmol/l or above)
What is NEWS2
- Used to identify and respond to patients at risk of clinical deterioration
- Validated in non-pregnant adults (over 16)
- 6 elements used to score (next card)
- NEWS2 over 5 ☞ should be screened for sepsis
- Elevated score doesn’t provide diagnosis, but helps to identify patients who need clinical review
What are some of the 6 different elements that make up NEWS2
- Respiration rate
- Oxygen saturation
- Systolic BP
- Pulse rate (BPM)
- Levels of consciousness / new confusion
- Temperature
What is ‘red flag sepsis’
- Not a formal diagnosis
- These patients are at high risk of deterioration
- Criteria to identify patients with a high likelihood of a degree of organ dysfunction
- Carry out sepsis 6 ASAP – increases chances of survival
- Sepsis 6 on next card
- Slightly lower criteria for amber flag
NEW2 is 7 or above, or 5/6 and…
- High lactate (over 2 mmol/l)
- Chemo in last 6 weeks
- Organ failure evident
- Patient looks very unwell
- Patient actively deteriorating
What is the sepsis 6
- senior help need senior decision maker
- Oxygen if O2 < 92%
- send bloods + cultures FBC, blood gas (latate and O2), CRP (inflammation), ALT + AST (liver function), U+Es (renal function) and cultures (to find causative agent)
- IV antibiotics to target source of infection. Removal or drainage of source of infection. Give ASAP as blood results won’t come back quick.
- consider IV fluids to correct hypovolaemia, improving pulse, BP, mental state, urine output + lactate
- monitor NEWS2 score, urine output, escalation etc
What blood tests to order for sepsis
- Full blood count (including white cell counts)
- Blood gas (for lactate and O2)
- CRP (inflammation)
- AST + ALT (liver function)
- U’s and E’s (renal function)
Name some symptoms of sepsis
- Tachypnoea
- Cold, clammy, mottled skin
- Severe breathlessness
- Loss of consciousness
- Change in mental state
- Slurred speech
- Flu like symptoms
- Hypotension
- Shivering
- High temp (or low temp in elderly)
- Tachycardia
- Neck pain and/or stiffness (meningitis)
- Photophobia (meningitis)
history factors
Mottled skin in meningitis
- Blotchy / spotty skin (may be harder to see on darker skin)
- Purpuric: doesn’t blanch when pushed with a glass
- Widespread
Cerebrospinal fluid in sepsis
- CSF surrounds brain and spinal cord
- Obtained by lumbar puncture
- Urgent transport of CSF to lab (cells deteriorate)
- Look at appearance (turbidity + colour)
- Glucose + protein estimation
- Microscopy for WBCs + RBCs
- Culture
- Referral for PCR
- Gram stain
