Sepsis Flashcards
Mediators
NO, bradykinin, histamine, prostaglandins, cytokines –> vasoactive
IL 1, TNF and IL6
Definition
Life threatening organ dysfunction caused by dysregulated host response to infection
Infection and persistent hypertension after fluid resus, or persistent lactate over 2 after resus, or vasopressor requirement to maintain MAP >65 in absence of hypovolaemia = sepsis as well
USE qSOFA
3 hour care bundles
Sepsis six High flow oxygen Blood cultures IV abx IVF Hb and lactate - if lactate above 4 need to give 30mL/kg crystalloid Measure hourly urine output
Assessment: History Respiratory Blood pressure Circulation and hydration Temperature SKin
6 hour care
Vasopressors if needed
Remeasure bloods
Systems
Cardiovascular Pulmonary Renal Gut Liver Haematological CNS
If more than 3 failed over 80% mortality
ARDS
Waterlogged lungs as a result of extravasation of inflammatory fluid and cells
Progressively tachypnoeic and hypoxic
CXR usually lags behind
CV failure
Vasodilatation
Loss of circulating volume
Myocardial depression
Other causes
Pancreatitis, ischaemia, multi-trauma, haemorrhagic shock
Surgical and infective Anastomotic Biliary Urinary COllection Infrected prosthesis Necrotic tissue
Non infective and surgical Ischaemic gut Ruptured aorta Major haemorrhage Trauma
Non-surgical and infective Pulmonary Urinary IV lines Soft tissue
Non-infective and non-surgical
Reperfusion
Acute pancreatitis
Things to do prior to surgery
Correct coagulopathy EUC optimisation ECG ABG Blood cultures
