INF1 - A. SEPSIS AND MENINGOCOCCAL DISEASE-COVERED Flashcards
what is sepsis
- body’s immune system has an extreme response to an infection
- the body’s reaction causes damage to it’s own tissues and organs
high risk groups for sepsis
75 yrs>
babies <1
diabetics
weakened immune system
just given birth, miscarried, abortion
physiological effects of sepsis on CVS
- hypotension - blood vessels dilate, and hence decreased oxygen to organs
- mottled skin and altered microcirculation
- increased lactate levels in septic shock
physiological effects of sepsis on hepatic system
increased bilirubin levels and liver enzymes and hence decreased metabolism
physiological effects of sepsis on renal system
- oliguria
- increased serum creatinine, blood urea nitrogen and biomarkers
physiological effects of sepsis on neurological system
- altered mentation
- confusion
- disorientation
physiological effects of sepsis on respiratory system
- decrease blood flow to heart and hence decreased oxygen levels in blood (hypoxaemia)
- decreased PaO2:FiO2 ratio
physiological effects of sepsis on haematological system
- low platelet count
- disseminated intravascular coagulation (abnormal blood clotting)
- petechiae (rash)
symptoms of sepsis in children
fast breathing
fit or convulsion
mottled, bluish, pale
rash that doesn’t fade
very tired/difficult to wake
feels abnormally cold
symptoms of sepsis in adults
slurred speech or confusion
extreme shivering or muscle pain
passing no urine in a day
severe breathlessness
it feels like your going to die
skin mottled or discoloured
what to use to identify sepsis at earliest stage
NEWS2 (is it 5 or more?)
why give oxygen when sepsis detected
hypoxia kills, this prevents tissue damage
we want SpO2 94-98% or 88-92% in COPD
why obtain IV access and take fluids
to identify pathogen causing infection
urine, sputum should also be cultured
why give IV antibiotics
give in 1 hour of diagnosis
broad spectrum - targets gram -ve/+ve
start smart then focus toolkit
why give IV fluids
adults - 500ml over less than 15 minutes
become dehydrated
leads to decreased reduced urine output
why monitor patient
use NEWS2 to monitor urinary output
may need catheter
repeat lactate levels once per hour if initial lactate elevated or if clinical condition changes
what is meningococcal disease
meningitis and septicaemia
what is meningococcal meningitis
- meninges around lining of brain and spinal cord are infected
- this damages blood vessels, bacteria can leak in and infect cerebrospinal fluid
- meninges are inflamed and brain pressure is increased
what is meningococcal septicaemia
- blood poisoning
- bacteria multiply uncontrollably in blood releasing endotoxins that damage blood vessels and hence stop supply of oxygen to organs
what is the causative organism of meningococcus disease
neisseria meningitides (meningococcus) - anaerobic gram -ve bacterium
(polysaccharide capsule)
how is meningococcus transmitted
aerosol
droplets from cough
direct contact with resp secretions
risk factors of meningococcus disease
young age, adolescence and early adulthood
>65 years
winter
absent spleen
immunocompromised state (HIV, chemo)
incomplete immunisation
cancer
liver/kidney disease
smoking
living in overcrowded places
cranial anatomical defects - congenital or acquired
cochlear implants
contiguous infection
sickle cell disease
signs and symptoms of meningococcal disease
fever
cold hands and feet
vomiting
drowsy
confusion
severe muscle pain
pale, blotchy skin / rash
severe headache
stiff neck
photophobia
convulsions/seizures
how to diagnose meningococcal disease
- physical exam (glass test)
- blood tests (liver, kidney)
- lumbar puncture (extract fluid from spine)
- CT scan of brain
how to treat meningococcal disease
- IV antibiotics (start smart then focus: broad to narrow)
- IV fluids to prevent dehydration and AKI
- oxygen
- steroid meds (help inflam)
what prophylaxis should be used for meningococcal disease
- close prolonged contact, give within 24 hours
- 1st line ciprofloxacin (single dose)
- 2nd line rifampicin (inducer of CP50 so lots of interactions)
long term complications of meningococcal meningitis
hearing loss
loss of sight
epilepsy
cognitive impairment
motor and coordination deficits
psychological disorders
long term complications of meningococcal septicaemia
limb deformities
limb amputation
ongoing organ failure
severe scarring
tissue loss
psychological disorders
what is the meningococcal NHS vaccination schedule
8wo - MenB vaccine
16wo - MenB vaccine
1yo - MenB vaccine
14yo - MenACWY vaccine
uni students (up to 25yo) - MenACWY vaccine
