L5 - Acute Sepsis In Emergency Department

Question 1

Define sepsis

Answer 1

A life threatening condition which arises when the body’s response to an infection is dysregulated and injures it’s own tissues

Question 2

In local infection WBC’s arrive via the blood and release cyotkines and chemokines which cause amplification of the immune response. They also cause local vasodilation and capillary leakage to allow the WBC’s to get to the site of infection. In sepsis because the infection is normally in the blood stream this happens systemically. What does this systemic vasodilation and leakage cause?

Answer 2

Hypovolaemia
Flushed and hot
Hypotension

Question 3

The effects of sepsis on the body’s organ systems can be remembered by the mnemonic ABCDE. Explain each element

Answer 3

Airways - no specific effect unless infection is in throat or neck, but if decreased consciousness occurs may be at risk of airway problems

Breathing - Raised respiratory rate to compensate for…Fluids and proteins leaking out of vessels decrease lung complince-> decreased oxygenation of blood

Circulation - hypovolaemia leading to vasodilation. To compensate this we have tachycardia. Hypovolaemia can cause end organ damage - insufficient saturation

Disability - reduced blood flow to brain -> confusion/drowsiness/slurred speech/agitation/anxiety/decreased consciousness

Exposure - high temperature due to bodies response to infection

Question 4

Give some symptoms of sepsis, can be remembered by the SEPSIS, acronym

Answer 4

Slurred speech
Extreme shivering or muscle pain
Passing no urine in a day 
Severe breathlessness
It feels like you’re going to die
Skin mottled or discoloured
also  - tachycardic to try to maintain BP

Question 5

What groups are especially at risk of sepsis?

Answer 5

Very young (<1 year old)
Elderly (>75 years old) or very frail
Pregnant or postpartum (within last 6 weeks)
Immunocompromised patients due to illness or drugs

Question 6

What NEWS2 score or higher should we consider sepsis?

Answer 6

5

Question 7

Red flag sepsis criteria is used to confirm sepsis in patients already under suspicion. Give three possible red flags, remember only one is sufficient to cause a response by the clinicians

Answer 7

AVPU changed from normal
Acute confusion 
RR above or equal to 25 per minute 
Needs oxygen to keep saturation above 92%/88 in COPD
HR above 130 per minute
Systolic bp below or equal to 90 (or from more than 40 from normal)
Not passed urine in last 18 hours
Non-blanching rash/cyanosis/mottled 
Chemo in last 6 weeks

Question 8

What are the elements of the sepsis 6 bundle?

Answer 8

GIVE
Oxygen
Fluids (consider)
Antibiotics

TAKE
Hb and lactate (lactate released in anaerobic respiration - released by tissues when they become hypoxic)
cultures
Monitor urine output (indicates kidney damage)

Question 9

what is the appearance of nisseria meningitidis under the microscope and gram stained?

Answer 9

gram negative (red) diplodocci

Question 10

What is the first line treatment for meningitis?

Answer 10

Ceftriaxone

Question 11

What would indicate a perforated bowel on an x-ray?

Answer 11

air under the diaphragm (black)

Question 12

Above what temperature is considered pyrexic?

Answer 12

38 degrees