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General Surgery > Sepsis > Flashcards

Sepsis Flashcards

1
Q

What is the sepsis 6?

A
  1. O2 Tx
  2. IV Abx
  3. IV Fluids
  4. Lactate ≥2
  5. Urine output ≤0.5L in 18h
  6. Blood culture
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2
Q

What is sepsis?

A

Life-threatening organ dysfunction caused by dis-regulated host response to infection.

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3
Q

What is septic shock?

A

Circulatory, cellular & metabolic abnormalities profound enough to increase mortality.
- sepsis
- persistent hypotension (MABP ≤ 65)
- lactate >2
(despite fluids)

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4
Q

Name 4 scoring systems for sepsis

A
  • NEWS2
  • SIRS
  • qSOFA
  • SOFA
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5
Q

What are the key red flags for sepsis?

A
  • SBP <90
  • RR >25
  • HR >130
  • lactate >2
  • UO <0.5ml / 18h
  • reduced GCS
  • recent chemo, AVPU, non-blanching rash, mottled, cyanotic, ashen
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6
Q

What is the pathophysiology of sepsis?

A

Disregulated immune response
- cytokine release = vasodilation, capll. fenestrations (overwhelms clotting factors = bleeding)
- hypotension & DIC
- tachycardia in attempt to maintain BP
- fluid overload (increased diffusion distance) tissue hypoxia = lactate
- peripheral vasoconstriction
- reduced systemic perfusion

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7
Q

What is DIC?

A

Disseminated intravascular coagulation
- fenestrations from cytokines blocked up by micro clots
- cytokines overwhelm clotting factors
= bleeding

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8
Q

What must be considered when giving O2 Tx? (Sepsis 6)

A

Target ≥94 : give 15L non-rebreathe

Target 88-92 : give O2 while do ABG to check for T2RF/CO2 retention

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9
Q

Which kills faster: hypoxia or hypercapnia?

A

Hypoxia! (always give O2 even when ABG inaccessible)

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10
Q

What is the procedure for giving Abx (Sepsis 6)?

A

Always: default IV Abx (see trust guidelines)
- look for previous cultures, infections, source of infection
THINK: allergies, contraindications (renal failure etc), resistance, dosage
Review daily.
(Swap to PO if no concerns, change type if no response, escalate to ITU if deteriorates)

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11
Q

What is the appropriate procedure when giving IV fluids (sepsis 6)?

A

500ml 0.9% saline bolus STAT
- repeat if no improvement
Septic shock - escalate to inotropes/ITU/senior
THINK: fluid overload in HF/RF/LF & older F pts (lower dose/slower rate)

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12
Q

How do you monitor response to treatment with the Sepsis 6?

A

Lactate serial every 30 mins for improvement

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13
Q

Do you need catheterise every patient to monitor UO (sepsis 6)?

A

No! Can weigh commode/bottles

THINK: if no UO are they in retention? Palpate bladder & scan if necessary.

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14
Q

Should blood cultures be taken before or after giving Abx (sepsis 6)?

A

Before, but don’t wait for results before giving Abx or if unable to get culture

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15
Q

What support is available when dealing with septic patients?

A
  • Ward/medical supervisor/reg
  • senior review
  • ITU
  • critical care outreach
  • 2222 crash team
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16
Q

What is the ‘Golden Hour’?

A

The principle that the Sepsis 6 should be implemented within 1 hour to reduce mortality.

17
Q

What tests are involved in a septic screen?

A

Cultures
- blood culture
- sputum culture
- urine dip & culture
- wound swab & culture
- stool culture
- lumbar puncture

Bloods
- baseline bloods (+ CRP, clotting factors)

Imaging
- CXR

18
Q

Who is at high risk of sepsis?

A
  • Elderly & very young (≤1; ≥75)
  • immunocompromised
  • recent surgery
  • chemoTx patients
19
Q

What are the complications of sepsis?

A
  • death
  • MOF
  • permanent organ damage (i.e. - RF)
  • arrhythmias
20
Q

What is post-sepsis syndrome? (PSS)

A

Psychological (offered support)
- anxiety
- depression
- PTSD
-

21
Q

What is Neutropenic sepsis?

A

Neutropenic patients (chemo/hereditary) get sepsis and have no neutrophils to fight the infection = a rapid decline

22
Q

What are the criteria for treating Neutropenic sepsis?

A

Patient AT RISK of neutropenia (don’t wait for FBC) with temperature >38 to be immediately admitted & treated with Sepsis 6 (don’t need to be systemically unwell).

Can discharge & send home with op Abx if respond well.

23
Q

How does sepsis cause an AKI?

A

Pre-renal cause

General Surgery (2 decks)

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