Acute Sepsis Flashcards
List the Classical Signs and Symptoms of Sepsis
Young patient, rapid deterioration, high resps temp and pulse and low BP). Acutely unwell, fever, headaches, lethargy and muscle aches. Possible meningitis signs (purpuric rash, neck stiffness and photophobia).
What is Sepsis?
Life threatening organ dysfunction due to a dysregulated host immune response to infection.
What is septic shock?
Persisting hypotension despite fluid resuscitation requiring additional treatment.
Define Bacteraemia.
Bacteria in the blood
How to identify sepsis?
EWS scores, clinical features (is there an infection?), GCS and red flag checks (Low BP, high pulse temp or resp rate)
What do you do if a patient has red flag sepsis?
Inform a senior for review
Send urgent investigations
Sepsis 6 bundle
What are the sepsis 6?
Oxygen Blood cultures IV antibiotics Fluid Challenge Lactate Urine output
What are the urgent investigations needed in sepsis?
FBC, U+E, EDTA for PCR, BMs, LFT, CRP, Clotting, blood gases and microbiology samples.
How does host immunity result in sepsis?
Cytokines (TNF and interleukins) are released by macrophages to give inflammatory response.
Cytokines stimulate growth factor, macrophages and platelets. Thrombin production increased, fibrinolysis inhibited by cytokines.
Humoral cascade is activated.
Infection is not controlled and DIC and/or organ injury.
Why do peripheries go cold and pale first?
Redirecting flow to major organs because the system is struggling.
What supportive care is used in treating sepsis?
ITU referral
Sepsis 6
Regular monitoring
What antimicrobial is used to treat sepsis?
Ceftriaxone
List the life threatening complications of sepsis.
Irreverisble hypotension Resp failure Renal Failure Raise ICP Ischamia and necrosis of limbs and digits
How to confirm a diagnosis of sepsis?
Blood culture, blood PCR and lumbar puncture if possible (microscope and culture or PCR)
Whats checked in CSF?
Glucose and proteins Culture Appearance (turbidity and colour) WBC and RBC Gram Stain PCR
