Acute Sepsis In The Ed Flashcards
What is the definition of “sepsis”?
Life threatening organ dysfunction due to dysregulated host response to infection
What is septic shock?
Persisting hypotension requiring treatment to maintain BP despite fluid resuscitation
What is the definition of bacteraemia?
Presence of bacteria in the blood +/- clinical features
What is involved in the “sepsis six” bundle?
“Give 3, take 3”
Give: IV antibiotics, IV fluids, Oxygen
Take: Lactate, Blood cultures, Urine output
What time frame should the “sepsis six bundle” be completed?
Within 1 hour
Which patients should be started on the “sepsis 6 bundle”
What are the early warning signs?
Patients who look “sick”
Patients with early warning score of greater than or equal to 3
Patients who display “red flags” - high respiratory rate, low BP, unresponsive
Patients will clinical features suggesting source (pneumonia, UTI, meningitis)
What urgent investiagations other than those in the “sepsis 6 bundle” should be carried out?
FBC, Urea and Electrolytes, EDTA for PCR, Blood sugars, LFTs, CRP, Coagulation (INR, PT), Blood gases, CSF, Urine etc.
How does the pathogenesis of sepsis lead to local and systemic effects in the patient?
Local: Endotoxins triggers inflammation an binds to macrophage, stimulates an inflammatory response, recruit RES, promotion of wound repair, cytokines, TNF, interleukins at site
Systemic: Cytokines released into the circulation, stimulation of GF, macrophages and platelets to control infection
Infection not controlled= sepsis
When the infection is not controlled as it should be, what systems are activated and what life threatening damage can these lead to?
Activation of RES and Humoral cascades
Disseminated Intravascular Coagulation (DIC) and organ injury as a result
How does DIC lead to organ dysfunction?
Cytokines cause thrombin to be formed and promotion of coagulation
Coagulation cascade leads to microvascular thrombosis
Leads to organ ischaemia, dysfunction and ultimately failure
