Sepsis Flashcards
What is sepsis?
Life threatening organ disfunction caused by a disregulated host response to infection
What is sepsis a result of?
A systemic inflamatory response
What local infections are most likely to precipitate sepsis?
Pneumonia (50%)
UTI (20%)
Abdomen (15%)
Skin soft tissue bone and joint (10%)
What disfunction of cytokines contibutes to sepsis?
An excessive amount of cytokines are released which body circulates causing a ‘cytokine storm’
What is the principle clotting factor?
Thrombin
Where does thrombin come from?
Thrombin stems from a protein called ‘tissue factor’
What is the pro-coagulant response during sepsis?
Bacteria and cytokines lead to tissue factor activating the coagulation cascade which ultimately leads to thrombin formation and the impairment of fibrinolysis.
This can lead to abnormal blood clotting throughout the body’s blood vessels which contributes to hypoperfusion, and finally multiple organ dysfunction syndrome
How does the inflammatory response contribute to tissue perfusion in sepsis?
Excess fluid disrupts gasseous exchange leading to hypoxia.
The cytokine storm and subsequent dis-regulated immune response can damage vital organs
What kind of shock is septic shock?
Distributive
What cells release cytokines?
Cytokines are mainly produced by macrophages and lymphocytes, although they can also be produced by polymorphonuclear leukocytes (PMN), endothelial and epithelial cells, adipocytes, and connective tissue.
What 3 responses to infection contribute to sepsis?
Host immune response
Inflammatory response
Pro-coagulant response
What are signs and symptoms of sepsis?
Fever
Heart rate >90bpm
Tachypnoea >22
Altered mental status
Hyperglycaemia (>7.7mmol) in the absence of diabetes
Hypothermia (known as ‘cold sepsis’) <36ºC
What is the NEWS2 score made for?
Detecting clinical deterioration
What are sepsis red flags?
What are sepsis amber flag?
Why is an elevated lactate level a red flag for sepsis?
It is a sign of anaerobic respiration which signifies hypoxia and can lead to metabolic acidosis
Why is recent chemotherapy a red flag of sepsis?
Patients are immunosuppressed so their leukocytes are reduced specifically their neutrophils
This is classed as neutropenic sepsis
What is the sepsis six?
First line hospital treatment for septic patients on arrival
What treament can help septic lactate levels, how?
Fluids, they dilute acids and help maintain a MAP of ≥65mmHg
Which septic patients should you be cautious administering fluids to, why?
Patients with congestive heart/cardiac failure, danger of pulmonary oedema
What would you give paracetamol for in septic patients, why?
Severe pain/discomfort
Paracetamol is an anti-pyretic, pyrexia is an essential ‘protective physiological response to aid in host defence’
What are some common symptoms of increased lactate level?
Early symptoms of lactic acidosis include:
Nausea and vomiting.
Exhaustion and fatigue.
Fast, deep breathing (respiratory compensation).
Muscle cramps and body aches.
More advanced symptoms may include:
Increasing weakness and drowsiness.
Delirium and confusion.
Ataxia.
Oliguria (low urine output).
When would you withhold IV antibiotics when otherwise indicated?
Only when there is a history of anaphylaxis
A rash after taking penicilin is not a contra-indication
Above what number NEWS2 score is considered indicative of red flag sepsis?
5 or above
What is the maximum dose of fluids you can give to a septic patient?
2000ml
What are the most common arrythmias that present with sepsis?
Tachycardia
Atrial fibrillation
Why is hyperglycaemia a symptom of sepsis?
Hormones your body makes to fight illness or stress can also cause blood sugar to rise.
