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Infection > Infection 3 Acute Sepsis > Flashcards

Infection 3 Acute Sepsis Flashcards

1
Q

Sepsis definition

A

Characterised by a life threatening organ dysfunction due to a dysregulated host response to infection

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2
Q

Septic shock defintion

A

persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation

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3
Q

Signs of sepsis SEPSIS

A

Slurred speech
Extreme shivering/muscle pain
Passing no urine in 24 hours
Severe breathlessness
It feels like you’re going to die
Skin mottled or discoloured

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4
Q

Local infection signs

A

Rubor
Tumor
Calor
Dolor

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5
Q

Sepsis mortality rate

A

28.9%

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6
Q

What happens in sepsis?

A

Vasodilation - ^ blood flow > rubor + calor
Amplification
Capillary leakage

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7
Q

Who is at risk of sepsis?

A

< 1 year old
> 75 years old / very frail
Pregnant + post partum
Immunosuppressant patient

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8
Q

Acronym for effects on sepsis on organ systems

A

ABCDE
Airways
Breathing
Circulation
Disability
Exposure

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9
Q

Effects of sepsis on airways

A

No specific effect
Unless infection is in throat or neck

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10
Q

Effects of sepsis on breathing

A
  • Tachypnoea
  • Fluid + protein leak into interstitial tissue > lung oedema + decreased lung compliance
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11
Q

Tachypnoea meaning

A

High respiration rate

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12
Q

Effects of sepsis on circulation

A
  • Hypovolaemia due to vasodilatation + leaky capillaries > hypotension
  • tachycardia
  • end organ damage
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13
Q

Effects of sepsis on disability + presentations

A
  • decreased blood flow to brain
  • confusion
  • drowsiness
  • slurred speech
  • agitation
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14
Q

Effects of sepsis on exposure

A
  • high temp due to hypothalamic response
  • hypothermia in elderly
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15
Q

When should you screen for sepsis?

A
  • clinician or carer is worried about patient
  • NEWS2 score >5
  • patient at risk of neutropenia
  • evidence of organ dysfunction
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16
Q

What test can show evidence of organ dysfunction?

A

Lactate levels > 2mmol/L

17
Q

What does NEWS2 measure?

A
  • resp. rate
  • O2 saturation
  • systolic BP
  • pulse rate
  • level of consciousness
  • temperature
18
Q

What is red flag sepsis?

A

Patient at high risk of deterioration
If NEWS 2 >7 or 5/6 with another condition

19
Q

What are the other conditions for red and amber flag sepsis?
And NEWS2 scores

A
  • lactate > 2mmol/L
  • chemotherapy in last 6 weeks
  • organ failure
  • patient looks very unwell
  • patient is actively deteriorating

Red 5/6
Amber 1-4

20
Q

What further reviews are needed in amber flag sepsis?

A
  • bloods + review results
  • senior clinical review within 1 hour
  • antimicrobial + escalation plan within 3 hours
21
Q

Management of sepsis

A

Sepsis 6

22
Q

What are the sepsis 6?

A

3 in 3 out
1- senior help
2- give O2 if needed
3- send bloods
4- IV antibiotics
5- control IV fluids
6- monitor

23
Q

O2 content equation

A

O2 content = [Hb] x SpO

24
Q

What levels should O2 be?
When would you give O2?

A

Normal 94-98%
Give O2 if <92%

25
Q

What bloods are tested in sepsis 6?

A
  • cultures
  • FBC
  • blood gas
  • CRP
  • Liver function test - ALT + AST
  • U + E - renal function test
26
Q

What should be monitored in sepsis 6?

A

NEWS2
Urine output
Any improvement?
Deterioration?

27
Q

How is cerebrospinal fluid obtained?

A

Lumbar puncture

28
Q

Why is urgent transport of cerebrospinal fluid to lab needed?

A

Cells deteriorate quickly

29
Q

What is the sepsis 6 ‘3 in, 3 out’?

A

IN- O2, antibiotics, fluids
OUT- blood culture, lactate+Hb, urine output

30
Q

NEWS 2 values for sepsis

A
  • resp rate >25/min
  • O2 sats <92%
  • systolic BP <90mmHg or 40+ drop from normal
  • heart rate >130bpm
  • consciousness - response to pain or voice only
  • temperature
31
Q

diagnosis confirmation of acute sepsis

A

blood culture
PCR of blood
microscopy, culture + PCR of CSF - lumbar puncture

32
Q

how is CSF examined

A
  • appearance - clear/cloudy
  • microscopy of RBCs or leukocytes
  • gram stain
  • PCR
33
Q

identify 5 life-threatening complications of acute sepsis

A
  • irreversible hypotension
  • respiratory failure
  • acute kidney injury
  • raised intracranial pressure
  • ischaemic necrosis of peripheries

Infection (16 decks)

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