S3) Acute Sepsis in the Emergency Department Flashcards
What is sepsis?
Sepsis: inappropriate inflammatory response to an infection causing organ damage that can be life threatening
uncontrolled release of cytokeins due to endotoxins released by bacteria that causes an inflammation. This results in vasodialation and septic shock
What is septic shock?
Septic shock is persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation
The terms sepsis, bacteraemia and septicaemia are not interchangeable.
Distinguish between them
- Bacteraemia is the presence of bacteria in the blood
- Septicaemia is generalised sepsis (outdated clinical term), bacteria or other pathogens have invaded the bloodstream
- Sepsis is a life-threatening response to infection
What is an Early Warning Score?
An early warning score (EWS) is a guide used by medical services to quickly determine the degree of illness of a patient
How do we recognise sepsis?
- Patients look sick or have raised EWS (3/more)
- Clinical suspicion of infection e.g. pneumonia, UTI, meningitis, etc
- Red Flag(s) e.g. high RR, low BP, unresponsive
Identify 5 red flags for sepsis
- Patient is unresponsive/confused
- Non-blanching rash - tumblr test
- HR > 130 bpm
- RR > 25 bpm
- Systolic BP < 90 mmHg
How does one react to a patient with Red Flag Sepsis?
Immediately:
- Inform senior doctor for review
- Send urgent investigations
- Complete Sepsis Six Bundle
Identify 7 urgent investigations
- FBC
- Blood gases
- Blood sugar
- Urea and Electrolytes
- Liver Function Tests
- C-Reactive protein (CRP)
- Other microbiology samples (CSF, urine, etc)
What is the Sepsis 6 Bundle?
- Give:
I. Oxygen
II. Antibiotics
III. Fluid challenge (increases blood volume and pressure)
- Take/measure:
I. Blood cultures (tells you microorganism)
II. Lactate (increases due to less perfusion to tissue)
III. Urine output (reduces to show kindneys arent working)
How does one confirm the diagnosis of acute sepsis?
- Blood culture
- PCR of blood
- Microscopy, culture & PCR of CSF (through lumbar puncture)
A lumbar puncture is only performed after checking contraindications.
Describe how CSF is examined
- Look at appearance (turbidity and colour)
- Microscopy of leukocytes and erythrocytes
- Gram stain performed
- Referral for PCR
Identify 5 life-threatening complications of acute sepsis
- Irreversible hypotension
- Respiratory failure
- Acute kidney injury
- Raised intracranial pressure
- Ischaemic necrosis of digits/hands/feet
What is meningococcal disease?
- Meningococcal disease is a bacterial form of meningitis, a serious infection of the meninges that affects the brain membrane
- It presents with a purpuric rash, light sensitivity, fever and neck stiffness
Which pathogen causes meningoccocal disease?
Neisseria meningitidis
How does meningococcal disease spread?
Spread by direct contact with respiratory secretions e.g. aerosols, nasopharyngeal secretions
Describe the properties of the meningococcus bacteria – Neisseria meningitidis
- Gram-negative diplococcus
- Numerous serogroups e.g. A, B, C, W-135
- Outer membrane acts as an endotoxin
- Most people are harmlessly colonised as it is found in nasalpharyngeal area of body
Where are the different serogroups for meningitis derived from?
Different serogroups are based on the polysaccharide capsular antigen
Which is the most predominant meningitis serogroup in England?
1000 cases/yr mainly Group B
What are the preventions for meningococcal disease?
- Prevention: Vaccination
I. Menningococcal C conjugate vaccine
II. ACWY vaccines
III. Serogroup B vaccines
- Prevention: Antibiotic Prophylaxis
sepsis pathophysiology
- vasodialation
- cpillary leakage
- amplification of immune system
(low blood pressure due to vasodialation and fluid leakage)
how do microorganisms tirgger the inflammatory cascade
- enter host
- adhere to host
- invasive into host
= inflammation
physiological features of sepsis
- respiratory (increased due to odema in lungs)
- cardiac (low blood pressure)
- CNS (reduced blood to the brain)
Renal (reduced urine output)
pyrexial ( hypothermia)
sepsis supportive and specific treatments/measurement
fluid = increases blood pressure (supportive)
02 = respiratory (support)
blood culture (specific)
lactate (supportive) - tells you about a perfusion
urine output (supportive) - shows kidneys not working
menigitis
inflammation of the meningeal lining of the brain and spine
bacterial meningitis = high neutrophil (polymorphs) count
viral meningitis = high lympocyte
BUT - TB meningitis = high lympocyte as its immune response is mainly driven by T cell response
