Acute Sepsis Flashcards
What is a common sign of sepsis?
Actute deterioration
Common signs of sepsis on examintation
Tachycardia
Hyperthermia/Pyrexia
Hypotensive
Tachypeic
What is Sepsis?
A life-threatening organ dysfunction due to dysregulated host respone to infection
What is Septic Shock?
Persisting hypotension due to infection reducing blood perfusion to tissues
What is bacteraemia?
Presence of bacteria in the blood
Name 5 red flags of Sepsis
- Responds only to voice or pain or are unresponsive
- Acute confusional state
- Systolic BP ≤ 90mmHg / drop > 40 from normal
- Heart rate > 130
- Respiratory rate ≥ 25
- Needs oxygen to keep SpO2 ≥ 92%
- Non-blanching rash, mottled/ashen/cyanotic
- Not passed urine in last 18h or UO < 0.5ml/kg/hr
- Lactate ≥ 2nmol/L
- Recent chemotherapy
What is the Sepsis Six Bundle (descirbe the steps)
- Titrate O2 to saturation target of 94%
- Take blood cultures
- Measure serum lactate and get FBC
- Administer empiric intravenous antibiotics
- Start intravenous fluid resuscitation to raise BP
- Commence accute urine output measurement
- Blood, Urine, Fluid, Antibiotics, Lactate, Oxygen
Name 3 investigations for Sepsis
- Full blood count to measure urea and electrolytes
- EDTA bottle for PCR to determine organism involved
- Blood sugar
- Liver function test
- CRP
- Coagulation studies
- Blood gases
How does Sepsis cause coagulation?
Cytokines are produced during sepsis which initiate production of thrombin, promoting coagulation.
Cytokines also inhibt fibrinolysis
Are there any potential side effects of coagulation?
Coagulation cascade leads to microvascular thrombosis and this can casuse organ ischaemia, dysfunction and death due to the small clots in the vasculature
What antibiotic should be used for meningitis?
Ceftriaxone
What are some complications of Sepsis
Irreversible hypotension
Respiratory failure
Acute kidney injury
Raised intracranial pressure
Ischaemic necrosis of digits, hands and/or feet
How do you confirm diagnosis of sepsis
Blood culture
PCR blood
Lumbar puncture if same - PCR and microscopy and culture of CSF
How do you examine CSF
Appearance - turbidity, colour
Microscopy WBCs and RBCs
Gram stain
PCR
Describe neisseria meningitidis, how is it divided into groups, what type of bacteria is it
Neisseria meningitidis
Gram -ve diplococcus
Numerous serogroups based on polysaccharide capsular antigen - allows evasion of immune response by preventing phagocytosis
Outer membrane acts as endotoxin
