Acute Sepsis Flashcards
What does the ED have for urgent management of acute sepsis?
‘Sepsis bundle’
What are some common signs of sepsis?
Generally unwell, temperature & chills (rigors)
Headache, nausea, general muscle aches, photophobia
Acute onset
What are some common signs of meningitis?
Widespread purpuric, non-blanching rash
Nick stiffness
Raised temperature
Raised pulse
What is the definition of sepsis?
Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection
(Host response has overreacted)
What is septic shock?
Persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation
What is bacteraemia?
The presence of bacteria in the blood (with or without clinical features)
What are some things measured when calculating the EWS?
Basic observations - eg respiratory rate, heart rate, temperature, blood pressure
What are some red flags?
High respiratory rate, low blood pressure, unresponsive
What is the sepsis six?
Oxygen Blood cultures IV antibiotics Fluid challenge Lactate/FBC Measure urine output
What are some urgent investigations required when someone is believed to have sepsis?
Full blood count, urea and electrolytes EDTA bottle for PCR Blood sugar Liver function tests C-reactive protein Coagulation studies Blood gases Other microbiology samples
What is a common pathogen that causes meningitis?
Neisseria meningitidis
What does the pilus enhance?
Attachment
What is the function of the polysaccharide capsule?
Promotes adherence, prevents phagocytosis (protection)
What does the lipopolysaccharide endotoxin released by Neisseria meningitidis trigger?
Inflammation
What are some examples of cytokines?
Tissue Necrosis Factors and Interleukins
What do cytokines initiate the production of?
Thrombin - thus promote coagulation
What do cytokines inhibit?
Fibrinolysis - stops fibrin dissolving
What is a major cause of shock and multiorgan failure?
Microvascular injury - results from coagulation cascade leading to microvascular thrombosis and hence organ ischaemia
What is included int the supportive care of sepsis?
Early referral to ITU
Sepsis Six
Regular monitoring and reassessment
What is the empiric choice of antibiotic for meningitis caused by Neisseria meningitidis?
Cetriaxone (can penetrate into the CSF)
What are some life-threatening complications of sepsis?
Irreversible hypotension, respiratory failure, acute kidney injury, raised intracranial pressure, ischaemic necrosis of digits/hands/feet
How is the diagnosis of sepsis confirmed?
Blood culture, PCR of blood, lumbar puncture (if safe)
Is Neisseria meningtidis Gram-positive or Gram-negative?
Gram-negative
What are the numerous serogroups of the meningococcus based on?
The polysaccharide capsular antigen
What does the outer membrane of the meningococcus act as?
An endotoxin
How is meningococcal disease spread?
Aerosols and nasopharyngeal secretions
After meningococcus is acquired in the body, what are the three outcomes?
Clearance, carriage or invasion
What is the fatality rate of meningococcal disease?
Around 10%
