sepsis

Question 1

What is sepsis

Answer 1

Not an infection it’s the body’s response to an infection, immune response, which is life-threatening.
is a life-threatening condition that arises when the body’s dysregulated immune response to an infection injures its own tissues and organs

Question 2

presentation of sepsis (Adult)

Answer 2

· Can initially look like flu, gastroenteritis or chest infection 
symptoms:
· Slurred speech or confusion
· Extreme shivering or muscle pain
· Passing no urine (in a day)
· Severe breathlessness
· It feels like you're going to die
· Skin mottled or discoloured

Question 3

presentation of sepsis (child)

Answer 3

· Is breathing very fast
· Has a fit or convulsion
o Febrile convulsion- causes them to have a seizure
· Looks mottled, bluish or pale
· Has a rash that does not fade when you press it
· Is very lethargic or difficult to wake
· Feels abnormally cold to touch

Question 4

presentation of sepsis (child <5)

Answer 4

· Is not feeding
· Is vomiting repeatedly
· Hasn’t had a wee or wet nappy for 12 hours

Question 5

what are the stages of sepsis?

Answer 5

SIRS-> Sepsis -> severe sepsis -> septic shock

Question 6

Systemic inflammatory response syndrome (SIRS) parameters

Answer 6

· Heart rate > 90 beats/ minute
· Respiratory rate > 20 breaths/ minutes
· Temperature <36.0 or >38.3
· Blood glucose > 7.7 mmol/L
· White blood cell count <4 or >12 x 109
· Acutely altered mental state eg confusion, slurring of speech
Whole body inflammatory response

Question 7

how do you diagnose Sepsis

Answer 7

With two or more SIRS criteria and a confirmed/ suspected clinical infection

Question 8

how can you have a negative blood cultures?

Answer 8

you don’t need to have viable live bacteria in your blood to develop sepsis as its an immune response not an infection

Question 9

how do you define severe sepsis

Answer 9

· Sepsis with the dysfunction of one or more organ systems

Question 10

what is septic shock

Answer 10

• complication of sepsis

- Final stage where hypotension persists despite adequate fluid resuscitation

Question 11

pathophysiology

Answer 11

· Excessive and disproportionate inflammatory response to infection –> organ dysfunction –> death

Question 12

pathophysiology of severe sepsis

Answer 12

Patients with severe sepsis suffer profound immune paralysis
o Compensatory anti-inflammatory response syndrome (CARS) oppose to SIRS
= immunocompromised

Question 13

pathophysiology of CARS

Answer 13

cytokine storm and hypo- inflammatory state. 
	o Hyper (cytokine storm- SIRS like response) and hypo inflammatory states 
	o Body realises its gone too far in its defences and its damaged itself so it reigns it back (too much) 
Over shoots into this Hypo inflammatory state.

Question 14

Dosing of antibiotics - absorption

Answer 14

Iv route- blood supply gets diverted away from non-essential organs (GI), extremities to make sure we have blood supply to essential organs (heart, lungs, brain, kidneys and liver)

Question 15

Dosing of antibiotics- distribution

Answer 15

vol of dist- effect fluid resuscitation has on vol of d - normal Vol of dist= 0.7L/Kg

• This will be higher in some sepsis patients due to fluid resuscitation
  
  • Need to therefore consider lipophilicity of drugs (particularly antibiotics)

Question 16

Dosing of antibiotics- metabolism

Answer 16

· Changes to hepatic metabolism

Changes to hepatic metabolism occur as a consequence of liver failure, phase 1 metabolism more affected than phase 2

Question 17

Dosing of antibiotics- Excretion

Answer 17

· Changes to renal excretion

Question 18

how can you diagnose sepsis with a suspected infection but not confirmed?

Answer 18

• you don’t have to have viable bacteria to develop sespis.
• bacteria release endotoxins, which are not destroyed by antibiotic use. They are stored in the GI tract
• in sepsis, blood is diverted away from the GI tract, making it ischaemic.
• an ischaemic environment disrupts the GI tract and blood barrier, allowing endotoxins to pass into circulation.
• the endotoxins will keep the immune system activated at an elevated level.

Question 19

What measure is used to determine pts at risk of sepsis?

Answer 19

NEWS (national early warning score) - 2 or more= THINK SEPSIS

Question 20

what aids diagnosis of Sepsis?

Answer 20

NEWS
previous hcp experience
lactate, crp and pro-calcitonin results

Question 21

what is qSOFA

Answer 21

measure of mortality- over 2

Question 22

how to determine sepsis?

Answer 22

• CRP= non-specific biomarker
• lactate= levels are increased when tissues are hypoperfused. (lack of oxygen)
• pro-calcitonin= helps to differentiate between bacterial and viral infections
• ○ Experience of healthcare professional
  ○ Screening tools e.g. NEWS

Question 23

what’s the sepsis 6

Answer 23

“golden hour, when sepsis is expected”
1. Administer high flow oxygen- target of more than 94%
a. ambulance
2. Take blood cultures including microbiological tests, consider urine swab and sputum tests.
a. Important to do this before IV antibiotics are given
3. Give broad spectrum antibiotics
a. Until microbiological cultures are back
4. Give intravenous fluid challenges
5. Measure serum lactate and Haemoglobin
6. Measure accurate hourly urine output
Consider catheterization if urine output is low

Question 24

role of the pharmacist in community

Answer 24

• early referral
• education and awareness
• helping with discharge
• identifying at risk groups (young children, elderly, immunocompromised, iv drug users, recent hops admission/icu admission, pregnancy or delivered within last 6 weeks, recent abx use, indwelling device (catheter))

Question 25

role of the pharmacist in hospital

Answer 25

• dosing advice
• part of icu team
• help with sepsis aid bags
• choice of abx
• duration of abx
• making sure first line treatment is given
• abx within golden hour