Sepsis Flashcards
What is sepsis?
where the body launches a large immune response to an infection causing systemic inflammation and organ dysfunction
Give an overview of the pathophysiology of sepsis:
1) in the face of overwhelming infection, immune cells stimulate the immune system using cytokines
2) some of these cytokines cause the endothelial lining of blood vessels to become more permeable, resulting in oedema and reduced intravascular volume
3) some cytokines activate the coagulation system, leading to the formation of thrombi
Why is thrombocytopenia a feature of sepsis?
the immune system activates the clotting system which results in thrombus formation and the consumption of platelets
What is the difference between sepsis and septicaemia?
Sepsis is often confused with septicaemia, which refers to microbiological invasion of the bloodstream. Sepsis is a separate clinical entity that can occur in response to any infection, with or without septicaemia.
What are the symptoms of an excessive cytokine realease?
- Vasodilation
- Increased vascular permeability
- Inappropriate activation of the coagulation cascade
- Immune system impairment
What is the name of the disease where the immune system stimulates thrombus formation, causing thrombocytopenia and uncontrolled bleeding?
disseminated intravascular coagulopathy (DIC)
Why is lactate raised in sepsis?
tissues have inadequate blood supplies leading to anaerobic respiration
What is septic shock?
where there is a large drop in arterial blood pressure in sepsis, despite fluid resuscitation
Give the 2 diagnostic features of septic shock:
1) blood pressure below 65mmHg despite fluid resuscitation
2) raised serum lactate (above 2mmol/L
What specific drug type is used to treat septic shock?
vasopressors such as noradrenaline
What is the name of the criteria used to check for sepsis-related organ failure?
sepsis-related organ failure assessment (SOFA)
Give 8 characteristics checked for in the sepsis-related organ failure assessment:
1) hypoxia
2) increased oxygen requirement
3) requiring ventilation
4) thrombocytopenia
5) reduced GCS
6) raised bilirubin
7) raised BP
8) raised creatinine
Give 6 risk factors for sepsis?
1) chemo, immunosuppressant or steroid use
2) very old (over 75) or very young (under 1)
3) pregnancy or childbirth
4) chronic conditions e.g. COPD or diabetes
5) surgery, recent trauma, burns
6) indwelling devices (catheters or central lines)
Give 7 clinical presentations associated with sepsis:
1) tachypnoea
2) reduce urine output
3) mottled skin
4) cyanosis
5) arrhythmias (new onset AF)
6) signs of potential sources (cellulitis, cough, infected wound)
7) confusion or drowsiness (particularly in elderly)
What scoring system is used to monitor the risk of deterioration and sepsis?
NEWS2
What 6 parameters are monitored in NEWS2 scoring?
1) temperature
2) heart rate
3) respiratory rate
4) oxygen saturation
5) blood pressure
6) consciousness
List the 8 blood tests that should be ordered to investigate sepsis:
1) FBC
2) U&Es
3) LFTs
4) CRP
5) blood glucose
6) clotting
7) blood cultures
8) VBG
In what time frame should a patient presenting with suspected sepsis be assessed and commenced on treatment?
1 hour
Give the sepsis six (BUFALO):
1) blood cultures
2) urine output
3) fluids
4) antibiotics (empiric broad spectrum)
5) lactate
6) oxygen
What specific signs relating to underlying causes may be found in septic patient’s?
Respiratory: coarse respiratory crepitations, bronchial breathing
Urinary: suprapubic tenderness, flank tenderness
Gastrointestinal: abdominal distension, abdominal guarding/rigidity
Skin / soft tissue: skin redness (erythema) / heat (calor)
Central nervous system: reduced GCS, nuchal rigidity, papilloedema, positive Kernig’s sign
Cardiovascular: new murmur, splinter haemorrhages
What 4 beside investigations are used in suspected sepsis patients?
- VBG - assess lactate level
- Capillary blood glucose - rule out hypo and hyperglycaemia
- Electrocardiogram - rule out arrhythmias
- Urine dipstick - assess for the presence of a UTI
Give the definition of neutropenic sepsis:
someone in sepsis with a neutrophil count below 1x10^9/L
Name 9 medications (and their indications) which can cause neutropenia:
1) chemotherapy
2) clozapine (schizophrenia)
3) hydroxychloroquine (RA)
4) methotrexate (RA)
5) sulfasalazine (RA)
6) carbimazole (hyperthyroidism)
7) quinine (malaria)
8) infliximab (multiple autoimmune conditions)
9) rituximab (multiple autoimmune conditions)
What is the threshold used for suspecting neutropenic sepsis in patients taking neutropenia-causing drugs?
temperature above 38 degrees C
