Sepsis Flashcards
Things that suppress the immune system (6)
- Cancer therapy
- malnutrition
- co-morbidities
- co-infection
- ageing
- nosocomial infection
What can immune suppressing things lead to? (5)
- Neutropaenia (neutropaenic sepsis)
- hypo-responsive immunity (measles suppress TH1 response)
- reactivation of dormant organisms (shingles)
- access to deeper tissue (catheter- associated UTI)
- better environments for organisms (glucose secretion in diabetes)
Dissemination of infectious agent
1) blood stream contains erythrocytes, platelets and PBMC (Peripheral blood mononuclear cell)
- also contains complement and acute phase proteins
2) TNF-a binds receptors to endothelial cells
3) PBMC produce pro-inflammatory cytokines in response to pathogen
- detects pathogen using PRRs, complement receptors and Fc receptors
Dissemination causes greatly inc fever, HR, CRP levels and WCC
- systemic inflammatory response syndrome
Features of PBMC-derived TNFa
1) TNF-a causes TF and iNOS expression on endothelial cells.
(TNF-a also activates blood neutrophils)
2) TF causes coagulation (slow down oxygenation (↓ tissue perfusion) → ↓ immune cells)
3) NO causes capillary leakage
4) Activated blood neutrophils to produce TNF-a
5) activated neutrophils form NETs
- severe non-localised oedema
- poor perfusion of tissues
- hypercoagulation
- risk of organ dysfunction
How can sepsis lead to problems?
1) Uncontrolled inflammation leads to SIRS
2) Localised increase in ↑clotting
3) ↑ TNFa, CXCL8, NO and TF
4) Hyper-coagulation → depletion of clotting factors → ↑ anti-coagulation → vasodilation, oedema, hypo-perfusion (due to fluid build-up → harder for oxygen to diffuse)
- localised clotting results in an inability to clot elsewhere → all lead to fluid loss from blood stream
- reduction in MAP is compensated for by constriction of blood vessels, inc heart rate
- ↑ lactate → decompensation and septic shock
What happens if there is severe ongoing immune response? (5)
- depletion of immune cells/proteins/molecules
- activation of anti-inflammatory
- ↑ TGF-B and IL-10
- ↓ TNFa, CXCL8 and NO
→ CARS
Compensatory anti-inflammatory response syndrome = a body-wide suppression of immune responses following overwhelming pathogen exposure
How to spot sepsis in adults?
Slurred speech or confusion
Extreme shivering or muscle pain
Passing no urine (in a day)
Severe breathlessness
It feels like you’re going to die
Skin mottled or discoloured
What is SIRS?
systemic inflammatory response syndrome
- a body wide response involving inflammatory mediators
- temp = ↑38 or ↓36
- HR = ↑90/min
- Resp = ↑20/min
- PaCO2 = ↓32mmHg
- WBC ↑12 or ↓4 x10^9/L
Definition of Sepsis
SIRS in the presence of documented or suspected infection with organ dysfunction
SOFA score of 2 or more
Definition of Septic shock
Septic shock is a subset of sepsis where particularly profound circulatory, cellular and metabolic abnormalities substantially increase mortality
What are the RED FLAGS for sepsis and how many do you need
NEED 1
- SBP less than 90 mmHg
- pulse above 130
- reduced GCS
- purpuric rash
- new O2 demand
- respiratory rate above 25
- urine output < 0.5 for 2 hours
- cyanosis skin
- any chemo in 6 weeks
What are the AMBER FLAGS of sepsis and how many do you need
2 OR MORE
- resp rate 21-24
- Arrhythmia
- SBP 91-100
- temp less than 36
- no urine 12-8 hours
- rigours
- immunocompromised
- trauma/ surgery in 6 weeks
Basic examination for sepsis
- Altered mental state
- rashes of skin
- capillary refill time
- temperature
- HR
- Resp rate
- 02 sat and BP
Sepsis 6
1) Administer high flow oxygen
- maintain O2 levels and tissue perfusion
2) Take blood cultures
- identify the pathogen of susceptibility testing
3) Give appropriate antibiotics intravenously
- threat of resistance outweighed by risk to patient
4) Give IV fluid challenges
- counter oedema and maintain a be
5) Measure serum lactate and haemoglobin
-septic shock risk, kidney function monitor tissue hypoxia state
6) Measure accurate hourly urine output
- monitor kidney function
(7. Get senior support early)
