sepsis Flashcards
What is sepsis
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
presentation of sepsis (Adult)
· 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
presentation of sepsis (child)
· 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
presentation of sepsis (child <5)
· Is not feeding
· Is vomiting repeatedly
· Hasn’t had a wee or wet nappy for 12 hours
what are the stages of sepsis?
SIRS-> Sepsis -> severe sepsis -> septic shock
Systemic inflammatory response syndrome (SIRS) parameters
· 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
how do you diagnose Sepsis
With two or more SIRS criteria and a confirmed/ suspected clinical infection
how can you have a negative blood cultures?
you don’t need to have viable live bacteria in your blood to develop sepsis as its an immune response not an infection
how do you define severe sepsis
· Sepsis with the dysfunction of one or more organ systems
what is septic shock
- complication of sepsis
- Final stage where hypotension persists despite adequate fluid resuscitation
pathophysiology
· Excessive and disproportionate inflammatory response to infection –> organ dysfunction –> death
pathophysiology of severe sepsis
Patients with severe sepsis suffer profound immune paralysis
o Compensatory anti-inflammatory response syndrome (CARS) oppose to SIRS
= immunocompromised
pathophysiology of CARS
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.
Dosing of antibiotics - absorption
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)
Dosing of antibiotics- distribution
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)
Dosing of antibiotics- metabolism
· Changes to hepatic metabolism
Changes to hepatic metabolism occur as a consequence of liver failure, phase 1 metabolism more affected than phase 2
Dosing of antibiotics- Excretion
· Changes to renal excretion
how can you diagnose sepsis with a suspected infection but not confirmed?
- 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.
What measure is used to determine pts at risk of sepsis?
NEWS (national early warning score) - 2 or more= THINK SEPSIS
what aids diagnosis of Sepsis?
NEWS
previous hcp experience
lactate, crp and pro-calcitonin results
what is qSOFA
measure of mortality- over 2
how to determine sepsis?
- 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
what’s the sepsis 6
“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
role of the pharmacist in community
- 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))
role of the pharmacist in hospital
- 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
