sepsis Flashcards
who are at increased risk of sepsis?
- < 1 year and > 75 years
- Impaired immune system
- Surgery within the last 6 weeks
- Breach of skin integrity
- Misuse of IV drugs
- Indwelling lines/catheters
define sepsis
A life-threatening organ dysfunction caused by a dysregulated host response to infection
define infection
Invasion of the body by harmful organisms, such as bacteria, fungi, or viruses. After an incubation period symptoms appear.
define septic shock
Sepsis with persisting hypotension requiring vasopressors to maintain a MAP ≥ 65mmHg and having a serum lactate >2mmol/L despite adequate fluid resuscitation
define shock
clinical syndrome where tissue perfusion & hence oxygenation is inadequate to maintain normal metabolic function
what is the pathophysiology of sepsis
- Not completely understood
- Immune mediated collection of physiological responses to an infectious agent
- Pathogen entry
- Activation of immune system & coagulation cascade
- Inflammation
–Vasodilation
– Leaky capillaries
–Amplification - Breathing
- Circulation
- Conscious levels
how do you diagnose sepsis?
- History taking and clinical signs and symptoms
- BP, O2 Sats
- Assessment/screening tools (SOFA;
qSOFA; NEWS; NICE – risk stratification)
what are the signs and symptoms of sepsis?
- Fever
- Hypothermia
- HR >90
- Tachypnoea
- Significant oedema
- Hyperglycaemia in the absence of diabetes
what can the early signs of septic shock look like?
–Altered mental status
* Confusion
* Decreased alertness
how does sepsis progress?
– Hypotension
– Cool peripheries and/or mottling
–Peripheral cyanosis
–Organ dysfunction
what is SIRS?
Multi-system response of the body
(may or may not be due to infection).
Defined by the presence of 2 or more
of the following features:
–Temperature > 38oC or <36oC
–Tachycardia > 90 bpm
– Respiratory Rate > 20 breaths per
minute
–WBC > 12 x109 /L or < 4 x 109/L
how do you associate organ dysfunction?
assessed using SOFA
(sepsis related organ failure assessment)
* Respiratory system
* Coagulation
* Level of consciousness
* CV system
* Liver function
* Renal function
what are the most common causes of sepsis?
–Gram positive bacterial pathogens
–Fungal organisms are ↑ rapidly
what are the sepsis 6?
oxyegn
cultures
fluids
IV antibiotics
lactate
urine output
why do you give oxygen in sepsis?
as inflammation disrupts the ability of O2 to reach the organs
what is the recommended oxygen to be given?
– High flow oxygen
– 15L/min
– Aim for sats of 94-98%
* Careful with some patient groups
why do we do blood cultures?
- Only reliable way to determine
therapy
–Sensitivities
–Resistance - Others
–Urine, Stool, Sputum
when and why do we give IV antibiotics?
- Give within 1 hour of admission to A&E,
improves patient outcomes - Give early broad spectrum iv antibiotics
what should be done after cultures and sensitivities are known?
–Tailor to known pathogens
–Review IV antibiotics every 24 – 48 hours
–Switch to oral agents as soon as possible
why do we give fluids?
Aim: improve cardiac output
* Hypovolaemia
–Relative
–Absolute (can coexist with relative hypovolaemia)
* Need to correct to prevent organ failure
how should fluids be given?
- Give quickly
- Assess response and act accordingly
- All septic patients should have a fluid
challenge unless they are showing signs of
overload
– 500ml, Hartmans in 15 minutes or less
– 250ml if heart failure/chronic kidney
disease (stage IV/V)
what are the fluids levels to assess?
–Urine output: >0.5ml/hr
–Pulse: <100 bpm
–MAP: >65mmHg
what is lactate?
- Marker of anaerobic respiration
- Altered blood flow in the capillaries,
thrombi can form, reduced oxygen to
organs = elevated lactate
– Lactate >2: sepsis, adverse prognosis
– Lactate >4: septic shock with a 50% mortality
why is urine output a good indicator?
beneficial in indicating organ perfusion
* Urine output:
–Falls before blood pressure drops
–Decline indicates a critical illness
what do you give in critical care?
- Blood transfusion
- Vasopressors
–Noradrenaline
–Vasopressin - Glycaemic control
- Enteral or parenteral nutrition
- Mechanical Ventilation
–Sedation
–Analgesia
–Neuromuscular
blockade - Stress ulcer prophylaxis
- Renal replacement therapies
