Sepsis Flashcards
Pathophysiology of sepsis?
- Systemic inflammation= cytokine release causing blood vessels to become more permeable= fluid leakage= oedema and reducing amount of O2 to tissues
- Activation of coagulation system= fibrin deposition trhoughout circulation compromising organ and tissue perfusion
lactate rises and meatbolic acidosis occurs
What is the process of disseminated intravascular coagulopathy (DIC)?
Activation of the coagulation system= firbin depostion= clot formation throughout body
Consumes platelets and clotting factors= thrombocytopenia (low platelets) and uncontrolled bleeding (haemorrhage) = DIC
What is septic shock and how is it diagnosed?
Occurs when arterial blood pressure drops despite adequate fluid resuscitation= organ hypoperfusion
Anaerobic resp begins and serum lcatate level rises
Diagnosed with:
* Low mean arterial pressure- despite fluid resuscitation (requiring vasopressors)
* Raised serum lactate (above 2mmol/L)
Treatment of septic shock?
Agressive treatment with IV fluids to improve blood pressure and tissue perfusion
Escalated for treatment with vasopressors e.g. noradrenaline
Blood tests for suspected sepsis?
- FBC
- U&Es- for kideny function and AKI
- LFTs- liver function
- CRP- assess inflammation
- Blood glucose
- Clotting to aseess for DIC
- Blood cultures
- Blood gas- lactate, pH and glucose
Sepsis 6?
Test for:
* Serum lactate
* Blood cultures
* Urine output
Treat:
* O2
* Broad spectrum antibiotics
* IV fluids
What is Neutropenic sepsis?
Sepsis in someone with a neutrophil count below 1x10(9)/L
Medical emergency
Treated:
Broad spec antibiotics- Piperacilin with tazobactam
What is the initial fluid resuscitation in a patient with sepsis?
Crystalloid (Hartmann’s solution or 0.9% sodium chloride) given as a bolus (500ml) over less than 15 mins.
Broad spec antibiotic good 1st line for urinary source of infection?
Ceftriaxone
