Acute Sepsis Flashcards
What is Sepsis
Sepsis is life-threatening organ dysfunction due to dysregulated host response to infection.
Generally, sepsis is an overreaction by the host to a severe infection. Sepsis is not infection – it is a deadly over response to infection. Note sepsis is extremely rapid onset.
What is septic shock?
Septic shock is persisting hypotension requiring treatment to maintain BP despite fluid resuscitation (give a significant amount of fluid to increase BP) – people in septic shock will not respond to this.
What is bacteraemia?
Bacteraemia is the presence of bacteria in the blood (with or without clinical features)
What is septicaemia?
Septicaemia – (outdated term) meaning generalised sepsis of the blood.
What is EWS (early warning score)
To diagnose sepsis quickly we use the EWS (early warning score) that focuses on red flag symptoms such as, high temperature, high HR, low BP, high respiratory rate and unresponsiveness. As well as this we use clinical observation that suggest a particular type of infection.
What should be done of the EWS score come back positive?
If these red flags and EWS are triggered immediately must inform senior doctor, send for urgent investigation and complete the sepsis six bundle: Oxygen, blood cultures, IV antibiotics, fluid challenge, check serum lactate full blood count and measure urine output.
What urgent investigations must be done once sepsis is suspected?
Urgent investigations: blood culture, full blood count, urea and electrolytes, EDTA bottle for PCR, blood sugar, liver function test, C-reactive protein (CPR), coagulation studies and blood gases.
What is a Purpuric rash?
Red or purple discoloured spots.
Purpuric rash (the glass tumbler test) – looking to see whether it blanches or not – goes pale then returns back to red. Purpuric rash is non blanching.
Discuss Meningococcal meningitis
Meningococcal meningitis caused by a bacteria called Neisseria meningitidis, spread by direct contact form respiratory secretion, most people are harmlessly colonised by this bacterium however in the unlucky few it rapidly becomes a lethal colonisation.
Neisseria meningitidis has a lipopolysaccharide Endotoxin the pilus of the bacterium enhances its attachment to macrophages. The polysaccharide capsule promotes adherence and prevent phagocytosis
Describe the inflammatory cascade?
Endotoxin binds to macrophages and triggers inflammation
Local – cytokines (such as TNF-alpha and Interleukin 1) are released to stimulate inflammatory response and wound repair and to recruit the reticuloendothelial system.
Systemic – cytokines spread and stimulate growth factor of macrophages and platelets the goal is to control the infection.
How does the inflammatory cascade lead to sepsis?
Sepsis – infection not controlled by the cytokines and host response – response begins to damage the host itself. Cytokines lead to activation of humoral cascades (antibodies) and RE system (phagocytes) causing circulatory insult including DIC (disseminated intravascular coagulation) and organ injury.
How is coagulation involved in sepsis?
Cytokines initiate production of thrombin and thus promotes coagulation. Cytokines also inhibit fibrinolysis. Coagulation cascade leads to microvascular thrombosis and hence organ ischaemia dysfunction and failure. Microvascular injury is the major cause of shock and multi organ failure.
This leads to progressive necrosis of body parts specifically extremities.
What is the sepsis 6 bundle?
1) Give high flow oxygen
2) Take blood culture
3) Give IV antibiotics
4) Give Fluid challenge
5) Measure Lactate
6) Measure urine output
What is important about the antibiotic treatment that should be given with meningitis infections?
Antibiotic treatment – different microorganisms affect different ages. The agent chosen must be effective against the most likely causes of the sepsis and penetrate the cerebral spinal fluid.
What are the life threatening complications of sepsis?
Life threatening complication of this sepsis is: irreversible hypotension, respiratory failure, acute kidney injury, raised intracranial pressure and ischaemic necrosis of limbs.
