Infectious Diseases 3 - Sepsis Flashcards
2 features of septic shock
systolic blood pressure <90 bpm
high lactate > 4 mmol/L
lactate rises due to hypoperfusion of tissues + anaerobic resp
what should you do if IV fluid boluses don’t improve BP + lactate in sepsis?
obviously senior input
but also escalate to HDU and ITU for inotropes
7 signs of severe sepsis
severe if any organ dysfunction
hypoxia oliguria AKI low platelets coagulation dysfunction hypotension high lactate >2
6 groups at higher risk of sepsis
extremes of age chronic conditions immunosuppression surgery/trauma/burns pregnancy indwelling devices
6 signs to look for on top of NEWS score for sepsis
signs of origin (wound, dysuria, cough etc) non blanching rash - mening reduced urine output mottled skin cyanosis arrhythmia
first sign of sepsis?
high resp rate
how do elderly often present with sepsis?
off their legs
confused / drowsy
why should you be very wary with neutropaenic or immunosuppressed patients?
even with sepsis their obs may not go off as they can’t mount a response
treat these patients as sepsis for sure with any temp >38
usually give an aggressive abx like tazocin
7 immediate investigations for sepsis
FBC UE LFT CRP clotting blood culture blood gas
4 investigations to search for the source of sepsis
urine dip + culture
chest x ray
CT scan if suspect abdo
LP if suspect brain
define the sepsis six and the deadline
3 tests:
blood lactate
blood culture
urine output (i.e. catheter)
3 treatments:
oxygen to maintain sats
empirical Abx
IV fluids
should happen within an hour of presentation
define neutropaenia and suggest various medications that may cause it
chemotherapy clozapine rheum arth meds carbimazole infliximab rituximab
neutrophils <1
