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SA infections > S3) Acute Sepsis in the Emergency Department > Flashcards

S3) Acute Sepsis in the Emergency Department Flashcards

1
Q

What is sepsis?

A

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

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2
Q

What is septic shock?

A

Septic shock is persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation

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3
Q

The terms sepsis, bacteraemia and septicaemia are not interchangeable.

Distinguish between them

A
  • 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  • Septicaemia is generalised sepsis (outdated clinical term), bacteria or other pathogens have invaded the bloodstream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
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4
Q

What is an Early Warning Score?

A

An early warning score (EWS) is a guide used by medical services to quickly determine the degree of illness of a patient

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5
Q

How do we recognise sepsis?

A
  • 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
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6
Q

Identify 5 red flags for sepsis

A
  • Patient is unresponsive/confused
  • Non-blanching rash - tumblr test
  • HR > 130 bpm
  • RR > 25 bpm
  • Systolic BP < 90 mmHg
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7
Q

How does one react to a patient with Red Flag Sepsis?

A

Immediately:

  • Inform senior doctor for review
  • Send urgent investigations
  • Complete Sepsis Six Bundle
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8
Q

Identify 7 urgent investigations

A
  • FBC
  • Blood gases
  • Blood sugar
  • Urea and Electrolytes
  • Liver Function Tests
  • C-Reactive protein (CRP)
  • Other microbiology samples (CSF, urine, etc)
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9
Q

What is the Sepsis 6 Bundle?

A
  • 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)

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10
Q

How does one confirm the diagnosis of acute sepsis?

A
  • Blood culture
  • PCR of blood
  • Microscopy, culture & PCR of CSF (through lumbar puncture)
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11
Q

A lumbar puncture is only performed after checking contraindications.

Describe how CSF is examined

A
  • Look at appearance (turbidity and colour)
  • Microscopy of leukocytes and erythrocytes
  • Gram stain performed
  • Referral for PCR
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12
Q

Identify 5 life-threatening complications of acute sepsis

A
  • Irreversible hypotension
  • Respiratory failure
  • Acute kidney injury
  • Raised intracranial pressure
  • Ischaemic necrosis of digits/hands/feet
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13
Q

What is meningococcal disease?

A
  • 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
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14
Q

Which pathogen causes meningoccocal disease?

A

Neisseria meningitidis

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15
Q

How does meningococcal disease spread?

A

Spread by direct contact with respiratory secretions e.g. aerosols, nasopharyngeal secretions

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16
Q

Describe the properties of the meningococcus bacteria – Neisseria meningitidis

A
  • 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
17
Q

Where are the different serogroups for meningitis derived from?

A

Different serogroups are based on the polysaccharide capsular antigen

18
Q

Which is the most predominant meningitis serogroup in England?

A

1000 cases/yr mainly Group B

19
Q

What are the preventions for meningococcal disease?

A
  1. Prevention: Vaccination

I. Menningococcal C conjugate vaccine

II. ACWY vaccines

III. Serogroup B vaccines

  1. Prevention: Antibiotic Prophylaxis
20
Q

sepsis pathophysiology

A
  • vasodialation
  • cpillary leakage
  • amplification of immune system

(low blood pressure due to vasodialation and fluid leakage)

21
Q

how do microorganisms tirgger the inflammatory cascade

A
  • enter host
  • adhere to host
  • invasive into host

= inflammation

22
Q

physiological features of sepsis

A
  • respiratory (increased due to odema in lungs)
  • cardiac (low blood pressure)
  • CNS (reduced blood to the brain)

Renal (reduced urine output)

pyrexial ( hypothermia)

23
Q

sepsis supportive and specific treatments/measurement

A

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

24
Q

menigitis

A

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

25
Q

clinical features of meningitis

A
  • headache
  • photophobia (difficult looking at bright lights)
  • vomiting
  • neck stiffness
  • irritable
  • carry out tumbler test on rash - non blanching so wont go away even if you put pressure on it = shows bleeding. If rash dissapears it just shows inflammation
26
Q

what is cerebral spinal fluid

A

plasma filtered from blood via epithelial cells to produce CSF

27
Q

antimicrobial therapy

A

should be administered rapidly to treat sepsis

28
Q

effects of sepsis on organs

A
  • Airways - can cause decreased conciousness
  • Breathing - raised respiratory rate and odema causes decreased lung compliance
  • Circulation -
29
Q

temperatire of person with sepsis

A
  • intialyy warm due to hypothalamic response due to infection but then cold due to hypothermia
30
Q

Difference between SIRS and SEPSIS

A

→ SIRS (Systemic Inflammatory Response Syndrome) due to an infection, trauma, or surgery. 2/4 fever, tachycardia, tachypnea, or abnormal white blood cell count

→ SEPSIS: due to infection and can be life threatening

SA infections (19 decks)

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