Sepsis

Question 1

What is sepsis?

Answer 1

Life threatening organ dysfunction caused by dysregulated response to infection causing injury to body tissues and organs.

Question 2

What is septic shock?

Answer 2

Sepsis with:

• persistent hypotension
• mean arterial pressure >/= 65mmHg
• lactate level >/= 2mmol/L

Question 3

Urgent management

Answer 3

• Give oxygen
• Take blood cultures
• Give IV antibiotics
• Give IV fluids
• Measure blood lactate and haemoglobin
• Measure hourly urine output
• Give vasopressor

Question 4

What do vasopressors do?

Answer 4

Cause a risk in blood pressure (noradrenaline and vasopressins)

Question 5

Noradrenaline

Answer 5

Acts on alpha 1 and alpha 2 receptors (some activity on beta 1).
Cause vasoconstriction
Some inotropic effect

Question 6

Vasopressins

Answer 6

Act on vasopressin V1 and V2 receptors.

Increase smooth muscle contraction and increase in water retention.

Question 7

Inotropes

Answer 7

Increase force of contraction and is used to treat myocardial failure (adrenaline and dobutamine).

Question 8

Adrenaline

Answer 8

Acts on alpha and beta 1 and beta 2 receptors. Increases myocardial contractibility.

Question 9

Dobutamine

Answer 9

Primarily a beta 1 agonist (little effect on beta 2 and alpha 1).

Question 10

Monitoring of sepsis

Answer 10

• Electrolyte imbalance (too much sodium and glucose)
• Muscle weakness
• Breathing compromised
• Eye care
• Mouth care
• Skin emollients
• GI protection
• VTE prophylaxis

Question 11

Opiates

Answer 11

Fentanyl is first line
afentanil is second line
Remifentanil is ideal sedative but its nonactive metabolites accumulate in kidney injury. Can be given alone or with propofol.

Question 12

Anaesthetic agents

Answer 12

Such as propofol.
Limited analgesia so may be added separately.
Consider if patient is on PN.