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Clasp Y3 - sepsis > Overview of sepsis > Flashcards

Overview of sepsis Flashcards

1
Q

What is colonisation?

A

The presence of a microbe in the human body without an inflammatory response

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2
Q

What is infection?

A

Inflammation due to a microbe

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3
Q

What is bacteraemia?

A

Presence of viable bacteria in the blood

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4
Q

What is sepsis?

A

Life-threatening organ-dysfunction due to dysregulated host response to infection.

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5
Q

What is septic shock?

A

A subset of sepsis with circulatory and cellular/metabolic dysfunction associated with higher mortality risk.

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6
Q

What is required for septic shock to be present?

A

Sepsis AND both of:

  • Persistent hypotension requiring vasopressors to maintain Mean Arterial Pressure (MAP) greater than or equal to 65 mm Hg,

AND

  • Lactate greater than or equal to 2 mmol/l.

(despite adequate volume resuscitation)

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7
Q

What is systemic inflammatory response syndrome (SIRS)?

A

Systemic inflammatory response syndrome (SIRS) is an exaggerated defense response of the body.

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8
Q

What can SIRS occur in response to and how does the body attempt to compensate?

A

To a noxious stressor (infection, trauma, surgery, acute inflammation, ischaemia or reperfusion, or malignancy,

To localise and then eliminate the endogenous or exogenous source of the insult.

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9
Q

Features of SIRS?

A

A non-specific clinical response including >2 of the following:

  • Temperature >38oC or <36oC
  • Heart rate >90 beats/min
  • Respiratory rate >20/min
  • White blood cell count >12,000/mm3 or <4,000/mm3 or >10% immature neutrophils

As well as infection, SIRS can also be caused by trauma, burns, pancreatitis and other insults

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10
Q

What is sequence of disease continuum for sepsis?

A

Infection

SIRS

Sepsis

Septic shock

Death

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11
Q

Sepsis occurs before SIRS. True/false?

A

False

Sepsis occurs after SIRS

Sepsis = SIRS with a presumed or confirmed infectious process

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12
Q

What is the main feature of septic shock?

A

Sepsis plus signs of at least one acute organ dysfunction:

  • Renal
  • Respiratory
  • Hepatic
  • Haematological [e.g DIC]
  • Central nervous system
  • Unexplained metabolic acidosis
  • Cardiovascular [hypotension]
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13
Q

What is the criteria for SIRS?

A

SIRS includes >2 of the following:

  • Temperature >38oC or <36oC
  • Heart rate >90 beats/min
  • Respiratory rate >20/min
  • White blood cell count >12,000/mm3 or <4,000/mm3 or >10% immature neutrophils
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14
Q

What is sepsis-2 vs sepsis-3?

A

Sepsis-2 (≥2 systemic inflammatory response syndrome criteria + infection).

Sepsis-3 (prescreening by quick Sequential Organ Failure Assessment [qSOFA]).

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15
Q

What is qSOFA (quick sequential organ failure assessment)?

A

The third international consensus definition for sepsis and septic shock (sepsis 3), used as a score for detection of patients at risk of sepsis outside of intensive care units.

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16
Q

What is septic shock?

A

Occurs when the arterial blood pressure drops despite adequate fluid resuscitation, resulting in organ hypoperfusion. Anaerobic respiration begins, and the serum lactate level rises.

It is diagnosed with:

  • Low mean arterial pressure (below 65 mmHg) despite fluid resuscitation (requiring vasopressors)
  • Raised serum lactate (above 2 mmol/L)
17
Q

Management of septic shock?

A

Septic shock requires aggressive treatment with IV fluids to improve blood pressure and tissue perfusion.

Patients should be escalated to high dependency or intensive care for treatment with vasopressors such as noradrenaline.

18
Q

How do vasopressors help with septic shock?

A

Vasopressors are medications that cause vasoconstriction (narrowing of blood vessels), increasing systemic vascular resistance and consequently mean arterial pressure (MAP), helping to improve tissue perfusion.

19
Q

What is SOFA (Sequential Organ Failure Assessment)?

A

Can be used to assess the severity of organ dysfunction, most often in the intensive care unit.

It takes into account signs of organ dysfunction:

Hypoxia
Increased oxygen requirements
Requiring mechanical ventilation
Low platelets (thrombocytopenia)
Reduced Glasgow Coma Scale (GCS)
Raised bilirubin
Reduced blood pressure
Raised creatinine

20
Q

Risk factors for sepsis?

A

Very young or old patients (under 1 or over 75 years)

Chronic conditions, such as COPD and diabetes

Chemotherapy, immunosuppressants or steroids

Surgery, recent trauma or burns
Pregnancy and childbirth

Indwelling medical devices, such as catheters or central lines

21
Q

What is assessed in the NEWS for sepsis?

A

Temperature
Heart rate
Respiratory rate
Oxygen saturation
Blood pressure
Consciousness level

22
Q

Additional signs of infection in sepsis?

A

Signs of potential sources, such as cellulitis, discharge from a wound, cough or dysuria

Reduced urine output

Mottled skin

Cyanosis

Arrhythmias, such as new-onset atrial fibrillation

A non-blanching rash can indicate meningococcal septicaemia

23
Q

What is mottled skin?

A

It occurs when blood flow to tiny vessels under your skin is disrupted. This results in a fine, bluish-red, lace-like pattern

24
Q

What is an early sign of sepsis?

A

A raised respiratory rate (tachypnoea) is often an early sign of sepsis

25
Q

What do elderly patients sometimes complain of in sepsis?

A

non-specific findings, such as confusion, drowsiness or simply “off legs”

26
Q

What are some investigations for suspected sepsis?

A

Full blood count for the white cell count and neutrophils

U&Es for kidney function and acute kidney injury

LFTs for liver function and as a possible source of infection

CRP to assess for inflammation

Blood glucose for hyperglycaemia and hypoglycaemia

Clotting to assess for disseminated intravascular coagulopathy (DIC)

Blood cultures to assess for bacteraemia

Blood gas for lactate, pH and glucose

27
Q

What are the 3 risk categorisations for sepsis?

A

Patients are risk stratified into low, medium and high risk.

28
Q

Management for sepsis?

A

High-risk patients need urgent attention and management.

Moderate-risk patients may be managed in the community where the diagnosis is clear, and it is safe to do so.

Safety-netting advice is essential when managing patients in the community, giving clear instructions about when they need further medical attention.

29
Q

What is the timeframe for sepsis treatment?

A

Patients with suspected sepsis should be assessed and start treatment within 1 hour of presenting.

30
Q

What is the sepsis six?

A

Used as management for sepsis.

The sepsis six involves three tests and three treatments.

31
Q

What are the components of sepsis six (3 tests and 3 treatments)?

A

Three tests:

Serum lactate
Blood cultures
Urine output

Three treatments:

Oxygen to maintain oxygen saturation 94-98% (or 88-92% in COPD)
Empirical broad-spectrum antibiotics
IV fluids

32
Q

What is neutropenic sepsis?

A

Neutropenic sepsis refers to sepsis in someone with a neutrophil count below 1 x 109/L.

It is a life-threatening medical emergency.

33
Q

What can a low neutrophil count be as a result of?

A

Usually the consequence of anti-cancer or immunosuppressant treatment.

34
Q

What medications can cause neutropenia (low neutrophil count)?

A

Chemotherapy (for cancer)

Clozapine (for schizophrenia)

Hydroxychloroquine (for rheumatoid arthritis)

Methotrexate (for rheumatoid arthritis)

Sulfasalazine (for rheumatoid arthritis)

Carbimazole (for hyperthyroidism)

Quinine (for malaria)

Infliximab (a monoclonal antibody used for various autoimmune conditions)

Rituximab (a monoclonal antibody used for various autoimmune conditions and cancers)

35
Q

Immediate treatment of neutropenic sepsis?

A

Treatment involves immediate broad-spectrum antibiotics, such as piperacillin with tazobactam (tazocin).

The other management aspects are the same as for sepsis but with particularly close monitoring and a low threshold for escalation.

Clasp Y3 - sepsis (4 decks)

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