7 Sepsis Flashcards
define sepsis
microbial invasion and systemic inflammation resulting in organ dysfunction
what 3 elements are present in sepsis
1 microbial invasion of sterile sites (blood, CNS, joints)
2 systemic inflammatory response (provoked by innate immune response then systemic)
3 organ damage- can be any organ (can be directly from bacteria or from physiological changes)
examples of symptoms in sepsis (4)
pale, temperature spike, blood in vomit, thirst without urinating
clinical definition of sepsis
2 or more of: temperature >38 or <36 heart rate >90 bpm respiratory rate >20/min white blood cells > 12x10^6 or < 4x10^6 ml
define neutropenia
low white blood cell count
define bacteraemia
presence of microorganisms in the bloodstream
define septicaemia
bacteraemia and sepsis
what’s the difference between sepsis and septicaemia
septicaemia is bacterial infection in the blood stream and sepsis is the body’s response to this
describe 7 steps in sepsis
1 the body’s immune response is triggered
2 white blood cells release inflammatory mediators and cytokines
3 vasodilation, capillary leak and blood clotting
4 not enough blood flow to the organs
5 build up of waste products, kidneys can’t make bicarbonate to balance blood pH-> metabolic acidosis
6 septic shock is when patient isn’t responding to treatment/fluids
7 multiple organ dysfunction syndrome (MODS)= 2 or more organs
what cascade has damaging effects in sepsis
cytokine cascade
cytokine cascade can lead to.. (4)
1 clotting activation
2 oxidative stress (release of oxidative mediators destroy bacteria but also normal tissue)
3 increased endothelial permeability
4 autonomic NS activation
non-infectious causes of systemic inflammatory response (4)
trauma, burns, pancreatitis, haemorrhage
common syndromes (and their organisms) leading to sepsis in the community (6)
UTI- E.Coli Pneumonia- S. Pneumoniae skin infection- S. Aureus Meningitis- N. Meningitidis Intra-abdominal infections- E.Coli Infective endocarditis- Streptococci, S. Aureus
3 main syndromes of infective endocarditis (situations it will occur)
1 elderly patients presenting with weight loss, inflammatory markers and are generally unwell
2 people who inject drugs, lose peripheral veins over time so move to large vessels (e.g. in groin), end up needing valve replacement
3 already had valve surgery, range of organisms on prosthetic valve is broad
what is infective endocarditis
an infection in the heart valves or endocardium. The endocardium is the lining of the interior surfaces of the chambers of the heart
risk factors of infective endocarditis (5)
valvular disease, prosthetic valve, IV drug use, central lines, implantable cardiac devices
what is rheumatic fever
antibody cross-reactivity following S. Pyogenes infection, damage to connective tissue, untreated repeat attacks can cause valve damage
what can S. Pyogenes bacteria cause
tonsillitis and scarlet fever
rheumatic fever
there is an ASOT antibody rise after tonsillitis
why is rheumatic fever not so common nowadays
due to prompt treatment of tonsillitis, scarlet fever etc so it doesn’t develop
presentation of infective endocarditis (3)
fever, lethargy, embolic infection (in bloodstream)
signs of infective endocarditis (4)
new murmur, skin lesions from emboli, roth’s spots (small lesions on retina), osler’s nodes (painful, red, raised lesions found on the hands and feet)
diagnosis of infective endocarditis
duke’s criteria
microbiology- persistent bacteraemia
cardiology- vegetations on echocardiogram
management of infective endocarditis
high dose IV antibiotics (usually 4 weeks)
may need valve replacement
common syndromes leading to sepsis in hospitals (5)
lines urinary catheters pneumonia (ventilator associated) post-op wounds neutropenic sepsis (when a patient with a low level of neutrophils gets an infection which they can't fight off and become septic)
take a blood sample before…
antibiotics are given, otherwise bacteria may not be recovered from the sample
What are the sepsis 6
1 oxygen 2 blood cultures 3 serum lactate 4 IV antibiotics within 1 hr 5 fluids in and out 6 urgent senior review
describe sepsis 1: oxygen
hypoxia kills, give oxygen to achieve SpO2 94-98% or 88-92% for known COPD
if unable to record= may indicate poor peripheral circulation and reason for concern
describe sepsis 2: blood cultures
take 2 pairs of blood cultures (from diff sites) immediately, also cultures from all invasive lines
all potential sources should be cultured (urine/sputum)
all suspected mod/severe pneumonia, send urine for legionella and pneumococcal antigen testing
describe sepsis 3: serum lactate
taken as urgent venous or arterial blood gas sample
high lactate= identifies patients at risk who may not be hypotensive
2-4mmol/L= give fluid bolus
>4= seek urgent senior clinical review
describe sepsis 4: IV antibiotics
every hour delay= increases mortality by 7.8% in septic shock
within an hour
describe sepsis 5: fluids in and out
if lactate is more than 2 or hypotensive, give 500ml fluid stat
review response
consider catheterisation
acute kidney injury is a frequent complication of high risk sepsis
describe sepsis 6: urgent senior review
ensure a senior clinician decision maker is requested to review and patient discussed with consultant
consider referral to critical care, if no services then consider urgent transfer to appropriate hospital
risk factors for resistant organisms (6)
frequent hospital admission prolonged stay in intensive care hospital stay overseas nursing home resident previous carriage previous antibiotic use
high risk red sepsis= 1 or more of these
new objective confusion oliguria (little urine) RR>25 pulse>130 or systolic BP<90 skin= mottled, cyanotic (blueish) lactate>2
