Sepsis Flashcards
What is the sepsis 6?
- O2 Tx
- IV Abx
- IV Fluids
- Lactate ≥2
- Urine output ≤0.5L in 18h
- Blood culture
What is sepsis?
Life-threatening organ dysfunction caused by dis-regulated host response to infection.
What is septic shock?
Circulatory, cellular & metabolic abnormalities profound enough to increase mortality.
- sepsis
- persistent hypotension (MABP ≤ 65)
- lactate >2
(despite fluids)
Name 4 scoring systems for sepsis
- NEWS2
- SIRS
- qSOFA
- SOFA
What are the key red flags for sepsis?
- SBP <90
- RR >25
- HR >130
- lactate >2
- UO <0.5ml / 18h
- reduced GCS
- recent chemo, AVPU, non-blanching rash, mottled, cyanotic, ashen
What is the pathophysiology of sepsis?
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
What is DIC?
Disseminated intravascular coagulation
- fenestrations from cytokines blocked up by micro clots
- cytokines overwhelm clotting factors
= bleeding
What must be considered when giving O2 Tx? (Sepsis 6)
Target ≥94 : give 15L non-rebreathe
Target 88-92 : give O2 while do ABG to check for T2RF/CO2 retention
Which kills faster: hypoxia or hypercapnia?
Hypoxia! (always give O2 even when ABG inaccessible)
What is the procedure for giving Abx (Sepsis 6)?
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)
What is the appropriate procedure when giving IV fluids (sepsis 6)?
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)
How do you monitor response to treatment with the Sepsis 6?
Lactate serial every 30 mins for improvement
Do you need catheterise every patient to monitor UO (sepsis 6)?
No! Can weigh commode/bottles
THINK: if no UO are they in retention? Palpate bladder & scan if necessary.
Should blood cultures be taken before or after giving Abx (sepsis 6)?
Before, but don’t wait for results before giving Abx or if unable to get culture
What support is available when dealing with septic patients?
- Ward/medical supervisor/reg
- senior review
- ITU
- critical care outreach
- 2222 crash team
What is the ‘Golden Hour’?
The principle that the Sepsis 6 should be implemented within 1 hour to reduce mortality.
What tests are involved in a septic screen?
Cultures
- blood culture
- sputum culture
- urine dip & culture
- wound swab & culture
- stool culture
- lumbar puncture
Bloods
- baseline bloods (+ CRP, clotting factors)
Imaging
- CXR
Who is at high risk of sepsis?
- Elderly & very young (≤1; ≥75)
- immunocompromised
- recent surgery
- chemoTx patients
What are the complications of sepsis?
- death
- MOF
- permanent organ damage (i.e. - RF)
- arrhythmias
What is post-sepsis syndrome? (PSS)
Psychological (offered support)
- anxiety
- depression
- PTSD
-
What is Neutropenic sepsis?
Neutropenic patients (chemo/hereditary) get sepsis and have no neutrophils to fight the infection = a rapid decline
What are the criteria for treating Neutropenic sepsis?
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.
How does sepsis cause an AKI?
Pre-renal cause
