6.2 - Sepsis - Exam Flashcards
Exam: List the risk factors for maternal sepsis that can occur from pregnancy to 42 days postpartum
- Obesity
- Diabetes/impaired glucose tolerance
- Immunosuppression
- Anaemia
- abnormal vaginal discharge
- hx of infections
- UTI
- Hx of Group B Streptococcal infection
- invasive procedures including amniocentesis
- Cervical cerclage (stitch in cervix)
- PPROM OR PROM
- Group A streptococcal infection
- Chorioamnionitis (intra-amniotic infection)
- c-section wound
- retained product
Exam: Describe the signs and symptoms of maternal sepsis
- febrile - rigors
- tachypnoea
- tachycardic
- blood pressure <90
- neutropenia
- elevated CRP
- Fetal Tachycardia
- cough
- unexplained abdo pain
- vomiting/or diarrhoea
- myalgia/back pain/ genereal malaise
- headache
- dysuria/frequency/odour
- new onset of confusion/reduce d mental state/agiated
- abnormal vaginal discharge
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Exam: Explain the systematic approach to prompt identification and treatment of suspected maternal
sepsis
Top 10 Pearls for Managing Maternal Sepsis
Recognition is key
Pearl 1. Always maintain a high index of suspicion for sepsis.
Pearl 2. Implement a rapid bedside tool for detection of maternal deterioration.
Move fast during the golden hour to save lives
Pearl 3. Implement sepsis bundles to facilitate rapid escalation of care.
Pearl 4. Laboratory and radiologic studies are keys to search for etiology and source control.
Pearl 5. Know your “bugs,” their likely origin, and that group A streptococcus can kill quickly.
Pearl 6. Choose antimicrobials tailored to the most likely diagnosis. - broad spetrum antibotic
Pearl 7. Fluid resuscitation should be initiated rapidly for patients with a blood lactate greater than 4 mmol/L (normal level 1) or mean arterial pressure less than 65 mm Hg. SBP <90
Beyond the golden hour
Pearl 8. Escalation of care is critical to survival.
Pearl 9. Once the patient is stabilized, get to the source of the problem.
Pearl 10. Anticipate and prevent adverse pregnancy outcomes.
Exam: Describe the midwife role in the identification, escalation and care of a woman with sepsis
- primary & secondary survey
Primary
Obtain hx
visual signs
- oygxen
- escalate care
- IV access and resus 30ml/kg - crystalloid and colloid solutions
- Blood cultures and FBC including lactate, u&e, coagags, CRP
- septic screen
- secrum lactate
- antibotics - broad spectum within the first hour (golden hour)
- strict FBC input output monitor urine output
secondary
HVS
Throat swab
wound swab
msu
placenta to pathology
stool sample
Breast milk spec
CSF if required
Sepsis 6
Exam: Define systemic inflammation
step 1 - pathogen detected immune response occurs (bacteria, virus, fungi)
Step 2 - the immune response occures sending WBC to invading the pathogen (pro inflammatory mediators and cytokins)
Step 3 - three things occur when the WBC infammatory response occurs
1. Vasodilation (blood vessels dialate
2. permaebility - in the small capillary causing leakage
3. microvascular coagulation occurs causing tiny clots resulting in hypoperfusion and hypoischaemia
These three things descease the ability to deliver blood to the organs
Step 4 - decreased blood flow to organs
Step 5 - metabolc acidosis - when organs dont receive enough blood required they are unable to elimiate waste products that have built up in the body. The kidney’s are unable to produce enough bicarb to balance the PH
Step 6 - Septic shock occurs when the blood pressure is unable to be maintained post giving 30ml/per kg fulid resus. causing lactic acidosis. induced hypotension/hypoper fusion abnormality
Step 7 Multiple organ failure
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Exam: Draw a flow chart that demonstrates the pathophysiological evolution of this condition
cell injury momentary local vasocontriction
cell death
release of kinins, histamine, prostagladin
local vasodilation
hyperanemia. capillary permebility
Exam: Differentiate systematic inflammation from sepsis. What is the key point of difference.
- SIRS Criteria
- Systemic Inflammatory Response Syndrome (SIRS) has been identified as relating to inflammation.
- two of the following conditions
- temperature >38 or <36
- Heart rate 90 bpm
- Respiratory rate >20 breaths
- or PaCO2 <32mmgh
- white blood cells >12000
- Sepsis is a result of infection that has overwhelmed the body’s defenses.
- altered mental state
- RR>20
- SBP <90
- The two conditions are similar, but distinct processes in the outcomes
- Systemic Inflammatory response syndrome
- QSOFA
- early detection
Exam: Define septic shock
- Septic induced hypotension regardless of fluid resuscitation
- hypoperfusion abnormailities
- lactatacidosis
- oliguria
- altered consious state
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Exam: What is the QSOFA? (NOTE: 2022 saw the release of the new Australian sepsis clinical care
standard that includes abnormal lactate LqSOFA however RANZCOG recommends the use of the
obSOFA which is described in your readings in the cloud. SIRS criteria is also no longer described
in the new standard).
*QSOFA quick Sequential Organ Failure Assessment (
* Allows quick clinical data assessment without waiting for the results of bloods etc
* Systolic blood pressue <90 mmHg (as per the NSW guidelines)
* Respiratory rate >25 breath/min or greater
* Altered mental state not alert
* Lactate highter then >4 normal is 1-2
Exam: Who is at risk of sepsis?
Maternal Sepsis - pregnancy to 42 days post partum
Anyone who is pregnant, has miscarried or aborted, or who has delivered a child
Fetal
Exam: What 3 key indicators would you assess for to complete an omqSOFA?
BP
mental state
RR
Exam: What are the parameters for an abnormal result?
bp <90
altered mental state
RR>25
Exam: How is this different to the non pregnant population?
Exam: Why are these parameters different?
- Larger blood volume in the circulatary system
- are more suspectible to infection due to compromsid immiussytem
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Exam: Which other investigations have an ‘obstetric range’?
Exam: REFLECT: Have you cared for a woman with sepsis? Was there a guideline for maternal sepsis?
Did it follow the SOMANZ guidelines? Check your hospital’s guidelines if you have not yet come
across a maternal sepsis guideline.
