Sepsis Flashcards
What is the definition of SIRS
2 of the following:
- Temp > 38.0 or < 36.0
- Heart rate > 90,
- Respiratory rate > 20
- WBC >12,000 or <4,000
What is the definition of sepsis, severe sepsis and septic shock
Sepsis = SIRS and infection.
Severe sepsis = organ dysfunction (confusion, hypoxia, oliguria or metabolic acidosis)
Septic shock = severe sepsis with hypotension or lactic acidosis
Explain the clinical presentation of sepsis
Fever,
Breathlessness,
Headache,
Nausea and Vomiting,
Diarrhoea,
Tachycardia,
Hypotension,
Pyrexia,
Peripherally vasodilated,
Hypoxia,
Tachypnoea
Explain the management of sepsis
- A-E assessment,
- Sepsis six,
- Imaging, viral PCR, urinalysis and lumbar puncture
What are the risk factors for cellulitis?
Advancing age, immunocompromised (diabetes) and predisposing conditions.
What are the clinical features of cellulitis?
- Erythema,
- Callor (heat)
- Swelling,
- Pain,
- Poorly demarcated margins
- Systemic upset,
- Lymphadenopathy
Evidence of barrier breach
What is the management of cellulitis?
Blood tests and culture,
Skin swab for culture
Oral/IV antibiotics,
Mark erythema,
elevate leg
Ultrasound to look for any drainable collection
What classification can be used in cellulitis?
Ero classification:
Class I - No signs of systemic toxicity or uncontrolled comorbidities.
Class II - Person is systemically unwell or has comorbidities.
Class III - Person has severe systemic upset or unstable comorbidities.
Class IV - Person has severe infection/sepsis
What is the pharmacological management of cellulitis?
Class I - Oral flucloxacillin or 2nd line oral doxycycline/clarithromycin for 7 days.
Class II - Short term hospitalization for IV Abx followed by discharge on outpatient parental abx therapy (OPAT). 1st line is IV flucloxacillin or 2nd line IV vancomycin.
Class - III/IV urgent hospital admission and consideration of surgical management.
What are the complications of cellulitis?
Severe tissue destruction, abscess formation, lymphangitis, recurrence, chronic lymphoedema or septic shock
Who should be admitted with cellulitis?
- Ero class 3/4
- Severe/rapidly deteriorating cellulitis
- Under 1yo
- Immunocompromised
- Significant lymphoedema
- facial cellulitis
What is the qSOFA score?
- Resp rate > 22
- Altered mentation
- Systolic BP < 100
Often used in ICU. If over 2 then high risk of mortality
Why can sepsis leads to ARDS and what is ARDS?
Sepsis increases vascular permeability which can lead to ARDS. ARDS is a non-cardiogenic pilmonary oedema and diffuse lung infiltration
What are some other causes of ARDS?
Pneumonia,
Sepsis
Aspiration
Pancreatitis (due to increased inflammatory markers)
Transfusion reactions
Trauma and fractures
Fat emboli
What are the signs and symptoms of ARDS?
Severe dyspnoea, tachypnoea, confusion, presyncope, fine basal crackles
