Sepsis Flashcards
What is Sepsis?
Sepsis is a life threatening organ dysfunction caused by a dysregulated host response to infection
According to NICE and the surviving sepsis campaign, if sepsis is not recognised early and managed promptly, what can it commonly lead to?
Septic Shock, multiple organ failure and death
According to Sepsis Trust (2018), when considering which children are more susceptible to developing sepsis, which of the following groups are known to have the highest risk?
24 weeks and 1 year old
What is Sepsis six?
Administer oxygen, take blood cultures, Give IV antibiotics, Give IV fluids, Check serial lactates, Measure urine
output.
When monitoring the intravenous fluid in a sepsis resuscitation you notice the infusion is 1 hour
behind in terms of remaining volume. What should you do first?
Make sure the infusion rate is infusing at the prescription ordered rate.
You are about to change the patients intravenous infusion and notice the cannula insertion site
appears very red and is oozing yellow pus. What is your next action?
Inform the patient’s doctor, insert a new cannula before starting the next infusion, remove the old cannula and
send the cannula tip for lab analysis.
The main goal of treating septic shock is:
Identification and elimination of the cause of infection.
Pneumonia typically affects which of the following parts of the respiratory system?
Bronchioles
You need to administer 15 litres of oxygen to a patient who has just been admitted with Sepsis, if
you follow the British Thoracic Society (2017) Emergency Oxygen Guidelines which mask will you
choose?
Non Rebreather mask
What part of the brain triggers the emetic or vomiting reflex?
The higher brain centres and the chemoreceptor trigger zone.
The surviving sepsis campaign promotes treatment within what time scale?
1 Hour of patient presentation
An ultrasound result comes back stating your patient has a kidney stone lodged in the urinary
tract, how will this most likely have caused a urinary tract infection?
Stasis of urine inside the urinary bladder due to obstruction attracts bacteria colonisation.
Your patient describes, red/brown discolouration of urine. What are they describing?
Haematuria
What are the indicators for an ECG?
Chest pain Use of accessory muscles History of drug use Low or high HR/ respiratory rate /BP Dizziness or fainting episodes
You really need to encourage your patient to follow the antibiotic regime, only taking half the
prescribed course is causing antibiotic resistance issues. How might you encourage them?
Provide adequate health education in an easily accessible/understandable format.
The pulmonary defence mechanisms help maintain low levels of microorganisms, these include
which mechanisms?
Cough reflex, Mucociliary clearance system and immune response.
In suspected pneumonia cases why might you send a C-reactive protein (CRP) level?
It is an acute phase reactant, a protein made by the liver that is released into the blood within a few hours after
tissue injury, the start of an infection or other inflammation
Your patient suffers regularly with xerostomia (a dry mouth.) you notice they have been struggling to swallow
food and have developed a cough. What do you suspect may have happened here?
Aspiration of food.
Who is most at risk from meningitis?
New-born babies and infants
The health care assistant shows you normal sinus rhythm on the patients 3-Lead trace, but says the patient
doesn’t respond when they call their name, according to the Resus Council (2015) what should you do next?
Check if you can rouse the patient by shouting a little louder in both ears.
According to sepsis trust 2018, what percentage of hospitals in England use a red flag sepsis criterion?
90%
How many patients a year in England acquire a healthcare associated infection as a consequence of care within the NHS
300,000 patients
What did the LeDer report in 2018 a key contribute to premature mortality?
Sepsis
What is the sepsis six for children?
Administer oxygen, take blood cultures, Give IV antibiotics, Give IV fluids restricted to a specific volume , Check serial lactates, Measure urine
output, early consideration of inotropes to control blood pressure.
What does SIRS stand for?
Sepsis has been defined as Systemic inflammatory response syndrome (SIRS) caused by infection both for adults and children
What is SIRS used for?
It is relevant in the identification of infection and uncomplicated sepsis
What does SOFA stand for?
Sequential organ failure assessment
What is a QSOFA?
Quick sequential organ failure assessment tool to aid in the identification of patients with infection who have a high risk of death
What is the difference between SOFA and QSOFA
SOFA tool requires multiple lab tests and wasn’t always quickly enough and would take too long to start treatment, often resulting in the golden hour being missed
qSOFA is a quick sepsis related organ dysfunction assessment score was designed.
Despite the SOFA is still considered by some clinicians at point of admission to be useful in predicting outcomes and more useful then SIRS
What score on a NEWS2 score should suspect sepsis?
Above 5
What can alter the scores on early warning systems?
- cardiac medication may mask tachycardia
- paracetamol may mask pyrexia
- patient with altered body shape naturally have a higher respiratory rate
- pregnant female will have a greater circulating volume
What is a PEWS?
The PEWS score is calculated using an observation chart. Each assessment includes respiratory rate and effort, oxygen requirements, heart rate, level of consciousness and clinical family concern
What does the assessment include within sepsis six?
Assess temperature Heart rate Respiratory rate Oxygen saturation Level of consciousness CRT in children under 12 years Blood pressure Examine for mottled or ashen appearance Ask the person, parent or cater about frequency of urination
What does the treatment include for sepsis
Antibiotics Analgesic and anti- emetics Nutrition and hydration Body posture Vasopressors Supportive care Surgery
What are the high risk side effects of sepsis?
Lethargy/ excessive tiredness Poor mobility Breathlessness Swollen limbs Joint and muscle pains Insomnia Hair loss Dry and flaking skin Taste changes Poor appetite Changes in vision Changes in sensation in limbs Repeated infections from the original site Reduced kidney function Feeling cold Excessive sweating
What are the psychological and emotional symptoms of sepsis?
- anxiety
- depression
- flashbacks
- nightmares
- insomnia
- PTSD
- poor concentration
- short term memory loss
- mood swings
What is the oxygen management for sepsis?
Aim for oxygen saturation of 94-98% and 88-92% in hypercapnia respiratory failure in adults
In critical illness, initiate treatment with a reservoir mask at 15L/min and aim for patients target saturations
Closely monitored and reassessed frequently
Blood gas sample may be required
What is neutropenic sepsis?
Neutropenic sepsis is potentially life threatening complication of neutropenia and is defined as a temperature greater then 38 degrees
What is a urinary tract infection?
An infection in the urinary system cause by the presence and multiplications of micro organisms which can affect the upper urinary tract and lower urinary tract
What is line sepsis?
Sepsis can be associated with the direct introduction of microbes into the blood stream through insertion or subsequent colonisation of bacteria.
It is almost avoidable therefore every case of Sepsis associated with an invasive device should be investigated with both the insertion and care techniques being reviewed
What is Pneumonia and when does it occur?
Pneumonia is defined as inflammation of the lung caused by bacteria.
Pneumonia occurs when there is a defect in normal host defence or pathogens overwhelm the immune response.
What is meningococcal sepsis?
This is a type of blood poisoning caused by the meningococcus bacteria which can also cause meningitis usually due to infection.
This carries a far worse prognosis than meningitis alone
What is the pneumonic for signs and symptoms of sepsis?
S- Shivering, fever or very cold E- extreme pain P- pale or discoloured skin S- sleepy, confused I- thoughts of impending doom S- short of breath
