overview of sepsis Flashcards
how do patients w infection presents? :
non- specific signs n symptoms : signs n symptoms related to site of infection
1- ——– : Respiratory infection:
Shortness of breath, cough, sputum
2- ——- : Urinary infection:
Frequency, dysuria, flank pain
3- —— : Skin infection:
erythema, pain
4- —– : Meningitis:
Headache, neck stiffness
5- —– : Abdominal infection:
pain, distension
6- arthralgia
temp / feels hot + sweaty
rigors
anorexia
fatigue
myalgia
systemic inflammatory response syndrom SIRS:
Clinical response to non-specific
insult
– Characterised by abnormal ‘— ’
* SIRS can be caused by — +— causes:
* —
* Infection = —
* —
* — (e.g. pancreatitis)
* –
vital signs
infectious n non infectious
haemorrhage
sepsis
ischaemia
inflammation
trauma
systemic inflammatory response syndrom - how do you know :
* Temperature < – °C or > – °C
* Heart rate > – beats/min
* Respiratory rate > – breaths/min
* Altered – status
* WCC < 4 x 109 /L or > 12 x 109 /L
(Normal range 4.0-11.0 × 109 /L)
* Blood glucose > – mmol/l in non-diabetic
(Normal range 4.0-7.0 mmol/l before meals)
36
38.3
90
20
mental
7.7
- Irish national early warning system :
- Used to identify a — patient
- Most countries have similar warning systems
- A system not a score
- Incorporates
Emphasis on clinical
judgement
“gut feeling”
Situation awareness
Patient or family concern - what’s in it - we document obersvetations as: Physiological observations
– – rate
– Oxygen – (+/- supplemental O2)
– – rate
– —
– Level of –
– –
deteriorating ( anticipate –> recognise –> escalate –> respond –> evaluate )
respiratory
o2 saturation
heart rate
blood pressure
consicousnes
temp
what is sepsis:
1- —-
2- triggering —
3- leads to —
- spesis is a — diagnosis
- not all — patients have sepsis
- other causes can include — , —
infection
host response
organ dysfunction
clinical
deteriorating
ischaemia and haemorrhage as post operative bleed
( check slide 21)
- Definitions of ‘sepsis’ provide a framework for—intervention
(i.e. facilitates – of patients that require resuscitation) - At present the interventions are:
- Resuscitation ( — )
- Referral (more – review, – care)
- 90% of cases with poor outcome in
the Australian sepsis database,
inadequate recognition was found
to be the most common feature
clinical
recognition
sepsis 6
senior
critical
the immune response of sepsis can be:
1- hyper active as :
2- hypo active as
inflammation coagualtion n apoptosis
anti inflamation anti coagulation and anti apoptosis
- Pathogen enters = – response
- — immune cells ( – ) recognise
and bind to – components. - Series of steps that result in phagocytosis +pathogen killing:
- associated with release of — by – , leading to therecruitment of additional — (e.g., leucocytes)
- This response is– by a mixture of
— and — mediators
host
innate
macrophages
pro inflammatory cytokines
macrophages
inflammatory cells
highly regulated
pro inflammatory + anti inflammatory mediators
response:
* Pro-inflammatory cytokines
– — response
– Simultaneous activation of— and—
– Uncontrolled/unregulated— inflammation
* Activation of complement, coagulation, and fibrinolytic
systems –
– may lead to —
systemic effect of sepsis:
- widespread cellular injury = precursor to —
- tissue —
- — injury
- altered rate of –
- —
SIRS
coagulation n firbionlysis
intravascular
microvascular thrombosis
organ dysfunction
ischemia
cytopathic
aopostosis
immunosuppression
( check slide 31) - most common source of sepsis is repsiraroy and then urinary n then intra abdominal
risk factors for sepsis:
Extremes of –
* –
* –
– Disease induced:
* cancer / asplenism / HIV/
renal failure / hepatic failure
– Medication induced:
* — , — , other —
meds
age
diabetes
Immunosuppression
chemo steroids m immunosuppressive
- Sepsis is a – -dependent medical emergency
- Mortality increases by 7.6% for each hour delay to appropriate antimicrobials
- sepsis 6 in 1 hour includes:
1- take 3 which are — , — , –
2- give 3 which are — , — , –
time
take:
- blood culture before 1 dose antimicrobial
- blood test include POC lactate
- urine output as a part of perfusion status assessment
give:
- oxygen if required
- iv fluid if deficit
- iv antimicrobial for local guidelines
principles of management:
1. Optimise – as — resuscitation / —
2. Eradicate –
3. Support – organ systems
perfusion
fluid
vasopressors
infection
dysfunctional
eradicate infection:
1. Identify likely – i.e. the – of the infectioncausing sepsis
NB to direct your choice of empiric antimicrobial(s)
2. – control
* — of abscess, washout of joint
* Removal of infected —
3. – therapy
* Consider likely – and— organisms
* Check recent microbiology results if available
* START – ‘get it right first time’
source
sote
source control
drainage
line/device
antimicrobial therapy
source n causative organism
microbiology
smart ( starting antimicrobials )
general principles then choosing antimicrobial:
1. — assessment: what is the likely site of infection?
2. —: Where do you think the patient got theinfection?
- Is it community, healthcare or hospital-acquired?
-local factors factors e.g. Antibiotic resistance rates
3. Previous —
- including from GP/other hospitals)
4 . Previous – results
5. History of –
clinical assessment
aquision
previous antibiotics
previous microbiology
allergy
summary :
* Sepsis is a Medical –
* Early —
* Appropriate intervention – —
* Appropriate — - critical care expertise
- not every infection is sepsis however everybody w sepsis has an infection
medical emergency
recognition
resucsciation
referral