Sepsis Flashcards
What is sepsis?
Life-threatening organ dysfunction caused by dysregulated host response to infection i.e. host response leads to injury of hosts own tissues
Considered a syndrome rather than a specific disease
Interaction between pathogen and immune system rather than only the pathogen effect itself
What is the pathophysiology of sepsis?
Which immune molecules are involved?
Immune system has complex interaction with pathogen= CYTOKINE RELEASE:
- vasodilation
- increased vascular permeability
- migration of WBC
- mitochondrial dysfunction
Dysregulation of haemostasis due to stimulation of coagulation
Endothelial barrier compromised
Vasodilation and increase permeability leads to hypotension and tissue hypoperfusion leading to change to anaerobic metabolism
TNF-alpha, IL-18 and IL1b
Why does septic shock occur?
What might a blood test show to indicate a patient is experiencing toxic shock?
Due to sepsis not responding to treatment resulting in cardio-circulatory failure:
- DROP IN BLOOD PRESSURE due to profound circulatory, cellular and metabolic abnormalities I.e. Leads to multiple organ failure
- persistent hypotension which requires vasopressors to be maintained =>65mmHg
Serum lactate >2mmol/L = sign of organ underperfusion and consequent switch to anaerobic respiration
What are the examples of end-organ failure which occur in sepsis?
ARDs Cardiomyopathy AKI Cholestasis Coagulopathy Delirium/encephalopathy Bone marrow suppression Myopathy
What are the most common sources of sepsis?
Pneumonia Blood stream infection Abdominal infection i.e. appendicitis/infectious diarrhoea/gall bladder infection UTI Catheter-related infection Skin or soft tissue infection Meningitis
I.e. bacteria most commonly compared with viruses/fungi/parasites
Who is at risk of developing sepsis?
What are clinical signs that someone is at risk of developing sepsis?
People at the extremes of life i.e. <1 or >65
Immunosuppressed
Chronic disease i.e. diabetes, COPD and CKD
Post surgery i.e. damage to normal mucosal barrier
Post-partum i.e. damage to normal mucosal barrier
Temp >38 or <36 Pulse >90 BPM RR >20 New confusion/drowsiness WBC >12 or <4 10^9 Blood glucose >7.7
How would you recognise a possible case of sepsis?
Possible infection in conjunction with circulatory compromise +/- unexplained deterioration
What is the clinical method of detecting sepsis? When should patients be escalated for query of sepsis based on this method?
NEWS/NEWS2
Resp rate SpO2 (2 scales i.e. one for those with respiratory disorder) -scale 2 used when COPD patients have hypoxic drive due to loss of CO2 sensitivity Oxygen administration Blood pressure Pulse Consciousness Temperature
When score =<5 OR when scores 3 in any of the sections
How is the qSOFA score used to assess whether patient suffering from sepsis?
Defines organ failure due to sepsis Diagnosis of sepsis requires 2(+) of the following: -Tachypnoea= RR>22 -hypotension= SBP<100 -Altered mentation= GCS<15
How might a patient with sepsis present?
Hypotension
High or low temp
Tachypnoea
Confusion
Shivering
-due to rigor
Low urine
-indicator of poor kidney perfusion
Drowsiness
Sweating
Skin mottling
-due to hypoperfusion
Cool peripheries
How do you manangement sepsis?
SEPSIS 6= do within first 1hr
I.e. 3 treatments and 3 investigations = 3 in, 3 out
Give IV fluids
- Resusitation= IV bolus crystalloid (200-250ml)
- maintenance dose= 125ml per hour i.e. 70kg person= 2500ml IV Hartmans solution per day
Give IV antibiotics
-within 1 hour
-empirical antibiotics to treat source of infection or unknown source if not clear
I.e. narrower spectrum antibiotics can be used when results from blood culture indicate the source of the infection and the possible resistance
Give oxygen (high flow)- if appropriate
- > 92% target
- need to be conscious of COPD
Measure lactate via VBG
- measure of tissue perfusion as indicates how much of tissue has switched to anaerobic respiration
- > 2 mmol/L = concerned
Blood cultures
-determining the pathogen acting as source of infection so can target Ab
Measure urine output (should be 30ml per hour) i.e. might need to catheritise
What investigation should be done for sepsis?
Bedside:
- urine analysis
- swabs
- ECG
Bloods:
- FBC
- U+E
- LFT
- coagulation
- CRP
- lactate via VBG
- cultures
Imaging:
-CXR
Invasive:
-lumbar puncture
How is sepsis monitored?
Hourly observations
Urine output and GCS
What are the complications asscociated with recovery from sepsis?
ITU admission to support respiratory and vaso support
- can lead to healthcare associated infections and myopathy
Prolonged immune-suppressive phase which leads to increase risk of secondary infection
Psychology effects
I.e. anxiety/difficulty concentration/clouded thinking/poor memory
What measures can be taken to prevent sepsis?
Vaccinations such as meningococcal vaccination
Hand hygiene
Prevention of hospital-associated infection
-mouth hygiene in ICU as can be main cause of hospital acquired pneumonia
Public awareness
-calling ambulance when there is change in consciousness or new onset confusion
Clean water
Safe childbirth
