FIM 9: Overview of Sepsis Flashcards
What are the non specific signs of infection?
High temperature Rigors Anorexia Fatigue Myalgia Arthralgia
What are the signs of a respiratory infection?
Cough, sputum, shortness of breath
What are the signs of a urinary infection?
Frequency, dysuria, flank pain
What are the signs of a skin infection?
Erythema, pain
What are the signs of an abdominal infection?
Pain, distension
What does SIRS stand for?
Systemic Inflammatory Response Syndrome
What is SIRS?
The body’s response to a nonspecific insult
Eg. infection (ie. sepsis), ischaemia, haemorrhage, inflammation, trauma, burns
What are the vital stats for someone with SIRS?
Temp >38 or <36
HR= 90BPM
20 breaths per min
What is the white cell count in someone with SIRS?
> 12x10^9
or <4
What is the blood glucose in someone with SIRS?
> 7.7 mmol/L in a non-diabetic
Which groups have an increased mortality rate from sepsis?
Age extremities
Genetic polymorphisms
Co-morbidities
What is sepsis?
Dysregulated host response and organ dysfunction in response to infection
What are the haematological signs of sepsis?
High lactate and creatinine
What are the non-haematological signs of sepsis?
Low BP
Hypoxia
Oliguria
Confusion
What complications can arise from the release of cytokines in sepsis?
Cytokines stimulate coagulation and fibrinolysis
May lead to microvascular thrombosis
What are the systemic effects of sepsis?
Tissue ischaemia
Cytopathic injury by cytokines
Delayed apoptosis of macrophages and neutrophils
Immunosuppression
What result can the delayed apoptosis of macrophages and neutrophils have?
Prolong immune response
Leads to multiple organ failure
Which populations are at a higher risk of getting sepsis?
Age extremities
Diabetics
Immunosuppressed
What are the circulatory effects of sepsis caused by?
Cytokines try to increase blood flow
What are the circulatory effects of sepsis?
Vasodilation
Increased permeability
Hypotension and hypoperfusion
What effect does sepsis have on the lungs?
Leaky blood vessels can cause oedema which causes hypoxia due to decreased diffusion
What effect does sepsis have on the kidneys?
Acute renal failure
What effect does sepsis have on the nervous system?
Dysfunction of BBB
Encephalopathy
What treatment should be given for sepsis in the first hour?
Take blood cultures, blood tests and urine output
Give oxygen, IV antibiotics and fluids
What should be considered before prescribing an antibiotic?
Likely site of infection Where was it acquired Previous antibiotics Previous infection Allergies
What is the most important thing to do as a junior doctor if a patient has sepsis?
Always refer to the consultant or critical care
What factors cause an increased risk of sepsis in pregnancy?
Mother older than 35 Premature membrane rupture Retained products Amniocentesis History of group B strep or pelvic infection Contact with group A strep
