Lecture 6

Question 1

What is sepsis?

Answer 1

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

• collection of physiological responses to infection
• causes an inflammatory response which becomes disregulatory
• reactions of immune response become dis regulated

Question 2

What is septic shock?

Answer 2

Subset of sepsis where particularly profound circulatory, cellular, and metabolic abnormalities substantially increase mortality.

Question 3

What are some signs of septic shock?

Answer 3

• signs of end organ damage
• hypotension (SBP <90)
• Lactate >4mmol

Question 4

What happens in local infection?

Answer 4

Rubor (red)
Tumor (swelling)
Calor (heat)
Dolor (pain)

Question 5

What occurs in sepsis?

Answer 5

• vasodilation of vessels (get WBC’s/fibrin into infected areas)
• therefore they have warm peripheries
• Leaky vessels to allow white cells to site of infection in tissues (causing swelling)
• upregulation of mediators

Question 6

What are the effects of sepsis on organs?

Answer 6

Airways: not much occurs, unless infection arises from neck/throat
Breathing: fluid leaking into lungs leading to lung oedema, raised respiratory rate (tachypnoea) as lungs become stiff
Circulation: vasodilation, decreases resistance and leakage, leading to hypotension. Tachycardia- pumps faster to try and maintain BP
Disability: reduced blood flow to brain- confusion, drowsiness, slurred speech.
Exposure: high temperatures (unless elderly:hypothermic)

Question 7

What is the lay symptom acronym for sepsis?

Answer 7

Slurred speech/confusion
Extreme shivering/muscle pain
Passing no urine
Severe breathlessness
It feels like you’re going to die
Skin mottled

Question 8

Why is sepsis important?

Answer 8

• high mortality rate

- rising incidence

Question 9

Who is especially at risk?

Answer 9

• very young (<1 year)-can’t communicate
• elderly/frail (>75 years)
• pregnant/post partum (immune suppression)
• patients with impaired immune system due to drugs/illness

Question 10

What is used to increase BP?

Answer 10

(You get to a point where you can’t increase BP)

Question 11

How is sepsis diagnosed?

Answer 11

• triggering early warning score (standardised score to assess deterioration)
• has signs of infection
• looks ill

Question 12

What is the national early warning score?

Answer 12

-identify & respond to patients at risk of clinical deterioration

1. Respiration rate
2. Oxygen saturation
3. SBP
4. Pulse
5. Level of consciousness/confusion
6. Temp

Question 13

What is the difference between the 2 oxygen scales?

Answer 13

One is used for patients with COPD

Question 14

NEWS 2 score?

Answer 14

..

Question 15

What is red flag sepsis?

Answer 15

• uses observations, not a formal diagnosis
• if you meet one of the red flag criteria’s it could be sepsis, under risk of deterioration

(AVPU, acute confusion, resp rate >25, oxygen req, high HR & BP, not passed urine, rash, recent chemo)

Question 16

What is AVPU score?

Answer 16

Alert
Voice
Respond to pain
Unconscious

Question 17

How is sepsis managed?

Answer 17

Sepsis 6 (set of 6 tasks, delivered at the same time to increase chance of survival)

1. Give oxygen
2. Take cultures (blood)
3. Give antibiotics (important)
4. Consider fluids
5. Take HB & lactate
6. Monitor urine output

(Each hourly delay in giving antibiotics increases mortality by 7.6%)

Question 18

What is the tumbler test?

Answer 18

Press on rash & disappears = non-blanching rash

Blanching rash = dangerous

Question 19

How do you take cerebrospinal fluid?

Answer 19

• lumbar puncture
• urgent transport to lab
• cloudy: white cells/bacteria in it
• gram strain
• refer for PCR