Lecture 5 - Acute Sepsis Flashcards
What is the definition of Sepsis?
A life-threatening organ dysfunction due to a dysregulated host response to infection
What is the definition of Septic shock?
A subset of sepsis where particularly profound circulatory, cellular and metabolic abnormalities substantially increase mortality
In simple terms what is sepsis?
It is characterised by inflammation
It’s where the reactions of the immune system to an INFECTION has become dysregulated/uncontrolled
What is bacteremia?
Presence of bacteria in the blood
What are the 5 signs of inflammation?
Rubor
Tumor
Calor
Dolor
Functio laesa
What is the pathophysiology of sepsis?
Infection stimulates Inflammatory response:
-Vasodilation (Rubor and Calor)
-Increased vascular permeability/capillary leakage (Tumor + Dolor)
-AMPLIFICATION of immune response (macrophages produce cytokines stimulating this)
What are the ways that microorganisms trigger the inflammtory response?
Gain entry into host
Adherence to host cells
Invasion into host cells/mucosal surfaces
What is the ABCDE effects of spepsis on organ systems?
Airways
Breathing
Circulation
Disability
Exposure
What airway issues may occur with sepsis?
No specific affect unlesss infection arises in throat or neck
Decreased consciousness may be at risk of problems of airways
What breathing issues may occur with sepsis?
Tachypnoae (Raised respiratory rate)
What circulation issues may occur with sepsis?
Hypovolaemia
Hypotension
Tachycardia
End organ damage
What disability issues may occur with sepsis?
Confusion
Drowsiness
Slurred speech
Decreased consciousness
What Exposure issues may occur with sepsis?
High temperature (Fever)
Elderly may get hypothermia
Why can respiratory issues (Tachypnoea) arise in sepsis?
Increased leakage of fluid out of capillaries into tissues like lungs decreases lungs ability for gas exchange
Respiratory rate increases to counteract this
Why can cardiac/circulatory issues arise in sepsis?
Vasodilation and increased capilary leakage means more fluid leaves blood
Results in hypovolaemia and hypotension
Tachycardia occurs, heart beats fastener to try and maintain the blood pressure/cardiac output
Organs don’t receive enough O2 blood so damage
Why may confusion and disability of the CNS occur in sepsis?
Reduced blood flow/perfusion to the brain
Why do renal issues occur in sepsis?
Reduced blood perfusion to kidney
Reduced volume of fluid in blood reduces urine output
Which groups of people are especially at risk to sepsis?
Very young (immune system not fully developed)
Elderly (immune systems weak)
Pregnant/6weeks post partum (partially suppressed immune system)
Immunocompromised patients (drugs or illness)
What system is used for screening for sepsis and when should it be used?
NEWS2 system
When score is 5 or more
Which group of people is the NEWS2 system NOT valid for?
Pregnant adults
Children < 16yrs
What 6 physiological measurements does NEWS2 use?
Respiration rate
Oxygen saturation
Systolic blood pressure
Pulse rate
Level of consciousness or new confusion
Temperature
What does lactate levels > 2mmol/L indicate?
Organ dysfunction (hypoxia)
What NEWS2 score might be indicative of sepsis?
5 or more
What is Red Flag Sepsis?
Stage of sepsis where IMMEDIATE action needs to be taken
Organ dysfunction is highly likely and the patient is at a high risk of deterioration
What NEWS2 score would suggest red flag sepsis?
7 +
Or
NEWS2 of 5 or 6 with:
-lactate > 2mmol/L
-Chemotherapy in last 6 weeks
-organ failure eviden
-looks extremely unwell
-active deterioration
What needs to be immediately started with a patient who has red flag sepsis? (NEWS2 > 7)?
Sepsis 6
What is Amber flag sepsis?
Stage of sepsis where urgent action within 3 hours needs to happen
What NEWS2 score may be amber flag sepsis?
NEWS2 5 or 6
Or
NEWS2 1-4 AND ONE OF:
-lactate > 2mmol/L
-Chemotherapy in last 6 weeks
-organ failure eviden
-looks extremely unwell
-active deterioration
What are the 6 tasks of Sepsis 6 that must all be done together/in short succession?
1.) Senior help
2.) Give O2 (if needed)
3.) Send bloods
4.) IV Antibiotics
5.) IV fluids (if needed)
6.) Monitor
When might you give oxygen as a part of the Sepsis 6 response?
When SpO2 (Oxygen saturation) is below 92%
When sending bloods what tests may be done?
Full Blood Count
CRP levels
Liver function test (ALT/AST)
Renal function test (Urine + Electrolytes)
Blood gas (O2 and lactate levels)
When giving IV antibiotics what are you considering?
The likely cause of infection
Where entry may have happened
Try and remove source of infection
Why do you have to be careful when considering IV fluids?
If Hypovolaemic give but need to do right amounts to avoid overloading the lungs
Tachycardia then give
What happens in the monitoring stage of sepsis 6?
Monitor NEWS2 score
Urine output
Any deterioration
Escalation?
In sepsis 6 remember give 3 take 3:
Give:
-Oxygen
-IV antibiotics
-IV Fluids
Take:
-Blood cultures
-Lactate
-Urine output
What is a non-blanching rash?
What is commonly used to test for a blanching rash??
A rash that doesn’t disappear with pressure
Usually a glass is pressed against the rash, if it doesn’t disappear with pressure it is non blanching
How can sepsis probably caused by meningitis be treated?
Antibiotics that can cross blood brain barrier (Ceftriaxone)
Vaccination
Prophylaxis for close contacts
What is prophylaxis?
Any means taken to prevent disease like immunisation (vaccines) against disease
What is meant by something being a notifiable disease or a notifiable microorganism?
Public Health England must be made aware of the case you have come across so further investigation can be done in the national interest of the countries health saftey
What IV antibiotic is usually given as a first line of treatment with suspected sepsis?
Ceftriaxone
When is Dexamethasone often administered?
Bacterial meningitis (could cause sepsis)
