4 - Sepsis Flashcards
What is the definition of sepsis?
Life threatening organ dysfunction caused by a dysregulated host response to infection
What is the definition of septic shock?
Severe sepsis leads to circulatory failure and metabolic abnormalities.
Persisting hypotension requiring active medical treatment and biochemical evidence of disturbed metabolism, e.g raised lactate
What type of bacteria is sepsis normally caused by in hospitals?
Gram negative bacteria
What are the common presenting symptoms of sepsis?
Common features of an infection with additional features of a dysfunctional body organ. E.g cardiac, CNS, liver
What should you do if you suspect sepsis?
Sepsis 6:
- Give IV antibiotics within hour
- Give IV fluid
- Give oxygen
- Take urine output with catheter
- Take lactate and Hb with bloods
- Take cultures
What should you do with a sepsis patient before administering IV antibiotics?
Take blood samples and CSF samples as antibiotics can affect these
What other supportive treatment, apart from oxyen administration, is given to a patient with suspected sepsis?
- Vasopressors
- Mechanical ventilation
- Inotropes
- Renal replacement therapy
What should you do if a septic patient is not responding to initial sepsis therapy?
Send them to intensive care for multi-organ support
Who is most at risk of sepsis?
- Over 75 or frail
- Below 1 year old
- Pregnant to 6 weeks post partum
- Patient with impaired immune system
When should you think SEPSIS?
- Patient triggering an NEWS >5
- Patient looks ill
- Signs of infection
What is red flag sepsis?
- Different tool for under 5’s and pregnant women
- When scoring over 3 on NEWS fill out sepsis sheet and if have red flag sepsis treat as though they have sepsis
What happens when a blood culture is taken when you suspect sepsis?
- Anaerobic and aerobic bottle put in machine
- If bacteria, CO2 will be produced so will turn indicator at bottom of bottle light
- Use this culture to grow and do a gram stain
Why do you get oedema and clotting in sepsis?
- Oedema: vasodilation all over body due to inflammatory response
- Clotting: altered coagulation system so clotting in small vessels but bleeding in other sites
What causes multiple organ dysfunctions in sepsis?
- Hypoperfusion due to decreased b.p and pericapillary oedema causing oxygen to have a larger diffusion pathway
- Clots in capillarys as there is a reduction in diameter due to the oedema
What are distinctive signs of meningitis?
- Purpuric non-blanching rash with tumbler test
- Neck stiffness
- Photophobia
- Vomiting
- Headache
What is septicemia?
Bacteria in the blood
What is meningitis caused by?
Mainly neisseria meningitidis bacteria attaching to meningeal lining and causing intense inflammation
Who is at high risk of meningitis?
- Meningococcal disease risk highest in young children
- High for adolescents and young adults
What is disseminated intravascular coagulation (DIC)?
- Widespread intravascular activation of coagulation
- Lots of small clots form using the anticoagulant factos so there is bleeding at the same time as clots being formed
- Low platelet count leading to petetchiae rash
What is petechiae?
- Common in meningitis patients
- Lesions on trunk and lower part of body, mucosal membranes and scelera
- Low platelet count and tiny bleed into skin
- Petechiae in meningococcus usually larger than those in thrombocytopenia
- Non-blanching
What is ecchymoses?
When petechiae coalesce and form larger lesions (>10mm). Severe DIC secondary to subcutaneous haemmoraghe
Why may someone have to have a limb amputated if they contract meningitis?
Necrosis due to vascular damage, lack of blood and oxygen to skin, clot in small vessel and haemorraghe
How do you manage of case of neisseria meningitidis septicaemia?
- Early recognition
- Antibiotics, e.g ceftriaxone
- Urgent investigation of CSF
- Supportive care
- Notify public health
- Prophylaxis for close contacts
- VACCINATE, Men B,C, ACWY
What would you do after taking a lumbar puncture in a suspected meningitis case?
- Get to lab in 1 hour
- Look at protein and glucose, protein increase glucose decrease
- Milky fluid indicates infection
- Microscopy
- Gram stain (red as negative cocci)
- Refer for PCR if suspect type of bacteria
How is meningococcus spread?
- Aerosol and nasal secretions
- Gram-negative diplococcus
- Outer membrane is endotoxin
- Stops immune response by preventing phagocytosis?
What bacteria cause bacterial meningitis?
Neisseria meningitidis
Streptococcus pneumoniae
Hib
How does neisseria meningitidis spread and cause infection?
Colonises the nasopharynx and then gets into the blood stream
What diseases does streptococcus pneumoniae cause, who is at risk and how is it tested for?
- Pneumonia, Meningitis, Sinusitis, Otitis media, Mastoiditis
- Risk: young children, older adults, smokers, chronic illness, malnutrition, alcoholism, sickle cell and asplenic
- Gram positive encapsulated allowing it to be antiphagocytic and antigenic
- Nasoswab, CSF, blood, sputum
What vaccinations are available for streptococcus pneumoniae?
- PPV: high risk individuals over the age of 2
- PCV13: 6 weeks to 6 years. antigenic. Over 65 years and high risk are offered it
Only responsive to vanomycin now!
In the meningitis vaccination, what parts of the bacteria are used?
ACWY = capsule as this is antigenic
B = subcapsular antigens
