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#Phase 2.2: Acute Care > Sepsis > Flashcards

Sepsis Flashcards

1
Q

What is Sepsis?

A

Condition where body launches large immune response to infection

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2
Q

What are the RF for Sepsis? (7 things)

A
  1. Very young / old (under 1 / over 75)
  2. Chronic conditions (e.g COPD / DM)
  3. Chemo / immunosuppressants / steroids
  4. Surgery
  5. Trauma / burns
  6. Pregnancy
  7. Medical devices (e.g catheters / central lines)
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3
Q

What does Sepsis cause pathophysiologically?

A

Systemic inflamm –> Affects functioning of organs

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4
Q

What is the main thing that is released in the pathophysiology of Sepsis?

A

Cytokines

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5
Q

What do Cytokines cause in Sepsis? (3 steps)

A
  1. Endothelial lining of blood vessels –> more permeable
  2. Fluid leaks out of blood –> Extracellular space –> Oedema
  3. Reduction in Intravasc volume
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6
Q

What does Oedema cause in Sepsis?

A

Reduction in O2 reaching tissues

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7
Q

How does Oedema in Sepsis cause reduction in O2 reaching tissues? (2 steps)

A
  1. Creates space between blood and tissues
  2. This reduces amount of O2 reaching tissues
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8
Q

What does Sepsis do in terms of coagulation?

A

Actives coagulation system

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9
Q

What does Activation of Coagulation system in Sepsis lead to? (2 steps)

A
  1. Deposition of Fibrin throughout circulation
  2. This compromises organ + tissue perfusion
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10
Q

What major complication can Activation of Coagulation system lead to in Sepsis?

A

Disseminated Intravasc Coagulopathy (DIC)

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11
Q

How can Sepsis cause Disseminated Intravasc Coagulopathy (DIC)? (3 steps)

A
  1. Consumption of Platelets + Clotting factors (used to to form clots within circ system)
  2. Thrombocytopaenia + Haemorrhages + X form clots
  3. Disseminated Intravasc Coagulopathy (DIC)
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12
Q

What does tissue hypoperfusion lead to in Sepsis, in terms of ABG results?

A

Rise in blood lactate

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13
Q

How does Sepsis lead to raised Lactate? (3 steps)

A
  1. Tissue is starving for O2
  2. Switches to Anaerobic resp
  3. Waste product of this = lactate
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14
Q

What are the numerical definitions of Septic Shock? (2 things)

A

Either:
1. Systolic BP less than 90 (despite fluid resus)
1. Lactate 4+

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15
Q

How should you Mx Septic shock?

A

Aggressive IV fluids
(to improve BP + tissue perfusion)

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16
Q

What should you do if BP + lactate levels not improving w IV fluids in Septic shock?

A

Send to ITU

17
Q

What meds can ITU use to Mx Septic shock no responding to IV fluids?

A

Noradrenaline (inotrope)

18
Q

How does Noradrenaline work in Mx of Septic shock?

A

Stimulates CVS –> improves BP + tissue perfusion

19
Q

What is Severe sepsis defined as?

A

Sepsis + Organ dysfunction

20
Q

What are examples of Organ dysfunction in Severe Sepsis? (7 things)

A
  1. Hypoxia
  2. Oliguria
  3. AKI
  4. Hypotension
  5. Thrombocytopaenia
  6. Coag dysf
  7. Hyperlactaemia (2+)
21
Q

What scoring system done by nurses is used to pick up signs of sepsis?

A

NEWS score

22
Q

Apart from NEWS score, what other signs of sepsis might you see @ exam? (9 things)

A
  1. Cough
  2. Tachypnoea
  3. Arrhythmias (e.g new onset AF)
  4. Wound discharge
  5. Cellulitis
  6. Non-blanching rash
  7. Mottled skin
  8. Cyanosis
  9. Dysuria / reduced urine output
23
Q

What is usually the FIRST sign of sepsis?

A

Tachypnoea

24
Q

What does a Non-blanching rash in Sepsis indicate?

A

Meningococcal septicaemia

25
Q

Which pt will have NORMAL obs + temp despite being super septic? (2 things)

A
  1. Neutropenic pt
  2. Immunosuppressed pt
26
Q

What is important about timing of investigations in sus Sepsis?

A

Do at same time as Mx (aka Sepsis Six)

27
Q

What is the immediate Mx plan for sus Sepsis?

A

Sepsis 6:
1. Take: Blood culture
1. Take: Lactate
1. Take: Urine output (w catheter PRN)
1. Give: Oxygen
1. Give: IV/IO Fluid
1. 1. Give: IV/IO Abx

28
Q

Apart from Sepsis 6, what is the aim of other investigations you will do?

A

Locating source of inf

29
Q

What investigations can you do for locating source of Sepsis? (6 things)

A
  1. CXR
  2. Swabs (of surgical wounds)
  3. Operative site assessment (CT / US)
  4. Cerebrospinal fluid sample (LP)
  5. Urine dip / culture
  6. Stool culture
30
Q

What is Neutropenic sepsis?

A

Sepsis + Low neutrophil count (less than 1)

31
Q

What is the main cause of Neutropenic Sepsis? (2 things)

A
  1. Anti-cancer tx
  2. Immunosuppressant tx
32
Q

What meds may cause Neutropenic sepsis? (6 things)

A
  1. Chemo
  2. Clozapine (schizophrenia)
  3. Hydroxychloroquine (RA)
  4. MTX (RA)
  5. Sulfasalazine (RA)
  6. Carbimazole (hyperthyroidism)
33
Q

What should be your threshold to Tx as Neutropenic sepsis until proven otherwise?

A

Temp over 38C

34
Q

What is the Med Tx of Neutropenic sepsis?

A

Tazocin (piperacillin w tazobactam)

35
Q

What is the Med Tx of Neutropenic sepsis?

A

Tazocin (piperacillin w tazobactam)

#Phase 2.2: Acute Care (31 decks)

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