Sepsis Flashcards

1
Q

What is sepsis?

A

A life-threatening organ dysfunction caused by a dysregulated host response to infection.

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2
Q

Give some patient groups who are more at risk of sepsis

A
  • Children <1
  • Adults >75
  • Frail
  • Immunocompromised
  • Post-surgery
  • Damage to skin e.g. burns, blisters, wounds
  • IV drug users
  • Lines or catheters
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3
Q

Give some symptoms of sepsis

A
  • Localising symptoms of infection e.g. productive cough, vomiting, diarrhoea, dysuria
  • Confusion
  • Drowsiness
  • Clammy/sweaty
  • Malaise
  • SOB
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4
Q

Give some signs of sepsis

A
  • Tachycardia
  • Tachypnoea
  • Hypotension
  • Fever or hypothermia
  • Cyanosis
  • Low O2 sats
  • Delayed CRT
  • Oliguria
  • Dry mucous membranes
  • Non-blanching rash
  • Mottled/ashen appearance
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5
Q

How is the CRT affected by sepsis?

A

Prolonged

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6
Q

How is urine output affected by sepsis?

A

Oliguria

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7
Q

Define oliguria

A

Reduced urine output (oliguria) is typically defined as <0.5ml/kg/hour in an adult

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8
Q

What RED FLAGS can be seen in sepsis in ‘breathing’

A
  • Tachypnoea → RR >/= 25
  • Low O2 sats → oxygen required to keep SpO2 >/= 92%
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9
Q

What RED FLAGS can be seen in sepsis in ‘circulation’?

A
  • Hypotension → systolic BP = 90 mmHg
  • Tachycardia → HR >130 bpm
  • Prolonged CRT
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10
Q

What lactate level is a red flag for sepsis?

A

Lactate >/= 2 mmol/l

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11
Q

What RED FLAGS can be seen in sepsis in ‘disability’?

A
  • Responds only to voice or pain, or unresponsive (ACVPU)
  • Acute confusional state
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12
Q

What RED FLAGS can be seen in sepsis in ‘exposure’?

A
  • Non-blanching rash
  • Mottled, ashen appearance or cyanotic
  • Urine output <0.5 ml/kg/hour
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13
Q

What urine output is a red flag for sepsis?

A

Urine output <0.5 ml/kg/hour

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14
Q

If sepsis is suspected, what are your management steps?

A

Blood cultures

Urine output

Fluids IV

Antibiotics IV

Lactate

Oxygen

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15
Q

What should always be checked before administering antibiotics?

A

allergies → red penicillin band?

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16
Q

What RR is a red flag for sepsis?

A

>/= 25 (tachypnoea in general suggests sepsis)

17
Q

What SpO2 suggest sepsis?

A

Hypoxaemia (<94%)

18
Q

What symptoms may indicate the chest as the source of sepsis?

A

a productive cough with purulent sputum

19
Q

What auscultation findings may indicate the chest as the source of sepsis?

A

bronchial breath sounds and/or coarse crackles indicate consolidation (pneumonia → sepsis)

20
Q

What percussion findings may indicate the chest as the source of sepsis?

21
Q

What intervention should be done in ‘breathing’ in patients with suspected sepsis? Why?

A

Sit up & 15L/min oxygen via non-rebreathe mask

To try correct hypoxaemia

22
Q

What investigations should be ordered in ‘breathing’ in suspected sepsis?

A

ABG

Portable CXR

Sputum culture (if appropriate)

23
Q

How is BP affected in sepsis?

A

Hypotension

Systolic BP = 90 mmHg or a drop of >40 mmHg from the patient’s normal blood pressure is considered red flags for sepsis

24
Q

How is pulse affected in sepsis?

A
  • Tachycardia is a common feature of sepsis
  • HR >130 bpm is a red flag for sepsis
25
How is CRT affected in sepsis?
Prolonged
26
Why is it important to assess the patient's fluid levels?
to inform resuscitation efforts
27
How can the patient's fluid levels be assessed?
oral fluids, IV fluids, urine output, drain output, stool output, vomiting
28
What causes oliguria in sepsis?
patients with sepsis are typically **intravascularly depleted** due to third space fluid loss
29
What is 3rd space loss?
this refers to losses into spaces that aren’t visible e.g. bowel lumen, retroperitoneum
30
What is your response to a hypotensive patient?
Insert 2x wide bore cannulae (one in each antecubital fossa) Give 500ml 0.9% saline over 15 minutes
31
What blood tests