Sepsis Flashcards
What is sepsis?
Life threatening organ dysfuntion due to dysregulated host response to infection (damages its own tissues and organs)
What is septic shock?
Subset of sepsis
Circulatory, cellular and metabolic abnormalities which substantially increase mortality
Reasons for definitions:
Common language improves communication
Educate the public
Establish criteria and thresholds
Determine eligibility for clinical trials
Simple terms: what is sepsis
Physiological responses to infection
Inflammation
Dysregulated immune system
What happens in local infection?
Rubor (red)
Calor (hot)
Dolor (pain)
Tumor (swelling)
What happens in sepsis?
Widespread inflammation:
Capillary leakage = oedema (plasma proteins leave capillary and draw water into interstitial space)
Vasodilation = redness and heat
Amplification of immune cells
ACROSS THE WHOLE BODY
Effects of sepsis on airways
No specific unless infection arises from throat/neck
Decreased consciousness could mean airway problems
Effects of sepsis on breathing
Tachypnoea (raised respiratory rate) Lung oedema (fluids and proteins leaking out)
Effects of sepsis on circulation
Hypovalaemia (decreased circulating blood) from capillary leakage and vasodilation
Hypotension
Tachycardia
Organ damage - not perfused
Blood pressure equation
Cardiac output x vascular resistance
Effects of sepsis (disability)
Reduced blood flow to brain Confusion Slurred speech Agitation Anxiety Low level of consciousness
Effect of sepsis (exposure)
Hyperthermia (hypothalamic response to infection)
Hypothermia (<36) in ELDERLY
6 signs of sepsis
S - slurred speech/confusion E - extreme shivering or muscle pain P - passing no urine S - severe breathlessness I - it feels like you are going to die S - skin mottled/discoloured
Who is at risk of sepsis?
Very young
Elderly
Pregnant/post partum (last 6 weeks)
Impaired immune system - illness/drugs
When do you think sepsis?
Triggering early warning score
Looks ill / relative concerned
Signs of infection
How are patients that are at risk of deterioration identified? (Sepsis)
National Early Warning Score (NEWS2)
NEWS2 physiological measurements
Respiration rate Oxygen saturation Systolic blood pressure Pulse rate Level of consciousness / new confusion Temperature
(ROSPLT)
What is red flag sepsis?
High likelihood of organ dysfunction
High risk of deterioration
Not necessarily sepsis but could be
What is the sepsis 6?
3 IN 3 OUT
In: antibiotics, fluids, oxygen
Out: blood culture, lactate & Hb, urine
How fast should sepsis 6 be done?
Within the hour!!!
Each hour delay increases mortality 7.6%
What occurs after you take a blood culture?
Collect sample Incubate Detects presence of CO2 (if CO2 produced = bacteria present) Gram stain Sensitivity test
Supportive investigations sepsis
FBC Urea Electrolytes Blood sugar Liver function test CRP Coagulation tests Blood gases
Specific investigations
Cerebrospinal fluid (CSF)
Throat swab
PCR
How is cerebrospinal fluid obtained and tested?
Lumbar puncture (between L3-4 or L4-5)
Estimate glucose and protein
(Low glucose = bacteria, high protein = bacteria)
Microscopy (RBC, WBC)
Gram stain
PCR
Meningococcus (cause and stain)
Neisseria meningitidis
Gram negative diplococcus
Outer membrane = endotoxin
Treatment and prevention of Meningococcus
Antibiotics (that cross blood brain barrier) = Ceftriaxone
Vaccination
Prophylaxis for close contacts
Notify public health (notifiable disease and organism)
3 ways mengititidis can act
First need to aquire
Clearance
Carriage (25% young adults)
Invasion
How is meningococcus spread and how does it evade?
Aerosols
Nasopharyngeal secretions
Evades immune response by preventing phagocytosis
