L5: Sepsis Flashcards
Define sepsis? (medical terminology)
Life threatening organ dysfunction
Due to dysregulated host response to infection
What is septic shock?
Subset of sepsis
Particularly profound circulatory, cellular and metabolic abnormalities substantially increase mortality
Why is it important to have definitions?
Common language–> improve communication
Educate the public
Establishment of criteria and threshold beyond which intervention is recommended
Provision of criteria to determine eligibility for inclusion in clinical trials
Define sepsis? (lay terms)
Physiological responses to infection
Characterised by inflammation
Reactions of immune system to infection becomes dysregulated
What are the signs of local infection?
Rugor--> redness Tumor--> Swelling Calor--> Heat Dalor--> pain (localised cellulitis)
What happens in sepsis?
Systemic inflammation due to dysregulation of immune system in response to infection
Vasodilation–> increase blood flow to the area (WBC, platelets, fibrin)–> warm peripheries on admissions
↑ vascular permeability (capillary leakage)–> allow more blood cells and factors out into the tissue–> swelling
Amplification–> Upregulation of mediator molecule (cytokines)–> pro-inflammatory and anti-inflammatory cytokines dysregulated–> sepsis
What are the effects of sepsis on the organs?
Airways–> not usually affected unless infection is in airways–> if become unconscious then airways might be
Breathing–> lung odema–> fluids and proteins leak out from capillaries –> decreased lung compliance –> Tachypnoea (increased resp rate) to compensate for reduced O2 in blood
–> Acidemia–> remove CO2 from blood–> quick rapid breathing to remove –> ↓O2 perfusion
Circulation–> Vasodilation–> ↓vascular resistance –> capillary leakage–> Hypovolaemia and hypotension
–> Tachycardia –> heart beats faster compensate for
decrease in BP
–> lack of blood flow to organs–> end organ damage
Disability–> Reduced blood flow to brain
–> confusion, drowsiness, slurred speech, agitation, anxiety or decreased level of consciousness
Exposure–> High temp due to hypothalamic response to infection
–> Beware could be hypothermic–> elderly–> so ill can’t control hypothalmic repsonse
What are the signs of sepsis?
S- Slurred speech or confusion E- Extreme shivering or muscles pain P- Passing no urine all day S- Severe breathlessness I- It feels like you're going to die S- Skin mottled or discoloured
Why is awareness of sepsis so important?
5% of emergency department admission
Overall mortality rate 28.9%
250,000 cases every year
Rising incidence 11.5% a year
Who is especially at risk of sepsis?
Very young < 1yrs old
Elderly >75yrs old
Pregnant, post partum (within last 6 weeks)
Patient with impaired immune system due to illness or drugs–> immunosupressants, IBD, poorly controlled diabetes
How is sepsis diagnosed?
Looks ill to health professional
Infection
Triggering an early warning score
What is NEWS2? Who is it used for? When?
National Early Warming Score 2
NHS system–> identify and respond to patient at risk of clinical deterioration
Validated for non pregnant adults >16yrs
Mandated use in acute and ambulance settings
Repetitive observation shows pattern/trend
What areas are covered in the NEWS2 test?
Respiration rate
Oxygen saturation (Scale 1 Non COPD patients, Scale 2 COPD patients– lower normal O2 saturation)
Systolic blood pressure
Pulse rate
Level of consiouness (AVPU) or new confusion
Temperature
What does a NEWS2 score tell you?
Doesn’t diagnose anything
Identify patients who need urgent clinical review
Score 5 or more–> ?Sepsis?
Clinical judgement important on whether to continue observations e.g. end of life not appropriate
What is red flag sepsis?
Not formal
Identify patient high likelihood of degree of organ dysfunction –> high risk of deterioration
Different chart used for under 5, 5-11 and pregnant women
