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MD3001 > sepsis > Flashcards

sepsis Flashcards

1
Q

what is sepsis?

A

life threatening organ dysfunction caused by a dysregulated host response to an infection

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2
Q

what is septic shock?

A
  • more severe form of sepsis, technically defined as ‘in which circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone
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3
Q

what will someone with septic shocks blood pressure and serum lactate be?

A
  • persistent hypertension requiring vasopressors to maintain MAP >/= to 65 mmHg
  • serum lactate = >2mmol/L
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4
Q

risk factors for sepsis?

A
  • very young (<1 yr) or very old (>70 yrs)
  • immunosuppressed (chemo, steroids, recent surgery ect)
  • pregnancy (inc post part, post termination, post miscarriage)
  • neonates
    loss of skin integrity
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5
Q

what are 3 examples of pathogens that can cause sepsis?

A

1- neisseria meningiditis
2- streptococcus pneumonia
3- streptococcus pyogenes
4- staph aureus

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6
Q

symptoms of sepsis?

A
  • fever, sweats or chills
  • breathlessness
  • headache
  • nausea and vomitting
  • diarrhoea
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7
Q

signs of sepsis?

A
  • tachycardia
  • hypotension
  • pyrexia
  • peripheral vasodilation
  • hypoxia
  • tachypnoea
  • hypothermia
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8
Q

what is sepsis 6?

A

the six steps in the investigation of sepsis and often referred to as sepsis 6

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9
Q

what are the 6 parts of ‘sepsis six’?

A

1- take bloods
2- take blood cultures
3- administer oxygen if required
4- administer IV antibiotics
5- administer IV fluid resuscitation
6- monitor urine output

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10
Q

what are other investigations you should do for sepsis?

A
  • imaging (CXR, echocardiogram, abdominal ultrasound)
  • viral PCR for diagnosis of influenza
  • urinalysis
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11
Q

what is ‘qSOFA’?

A

adult patients outside of ICU with suspected infection are identified as being at heightened risk of mortality if they have a quickSOFA score
- meeting >/= to 2 of the following criteria:
- resp rate of 22/min or greater
- altered mutation
- systolic blood pressure of 100mmHg or less.

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12
Q

what are the immune mechanisms underlying sepsis?

A
  • Cytokine mediated hyper inflammatory phase which most patients survive
  • subsequent immune suppressive phase
    (Patients failure to eradicate the the invading pathogen and are susceptible to opportunistic organisms)
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13
Q

describe the pathophysiology of sepsis?

A
  • system wide release of cytokines, mediators and pathogen related molecules
  • activation of coagulation and complement pathways
  • widespread inflammation, tissue damage and multi organ dysfunction.
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14
Q

what are the inflammatory mechanisms underlying sepsis?

A

During sepsis, systemic activation of the innate immune system by PAMPs(pathogen associated molecular pattern) and DAMPs (damage associated molecular pattern) results in a severe and persistent inflammatory response characterised by an excessive release of inflammatory cytokines such as IL-1, TNF, and IL-17, collectively known as the “cytokine storm”

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15
Q

what is the early response (innate immune system) to sepsis?

A

release of:
- IL-1
- IL-6
- IL- 8
- IL-12
- IL-18
- TNF alpha
- INF gamma

  • activation of compliment, coagulation and phagocytes
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16
Q

what is the cellular immune response to sepsis?

A

activation of B cells, neutrophils and myeloid derived suppressor cells

17
Q

what is the humeral immune response (adaptive immune system) to sepsis?

A

production of immunoglobulins
IgM
IgG

18
Q

what 3 things lead to deterioration on sepsis?

A

1- decrease of HLA-DR expression
2- T cell exhaustion
3- apoptosis of immune cells

19
Q

what 3 things fall under immunoparalysis?

A

1- nosocomial infection
2- viral reactivation
3- endotoxin tolerance

20
Q

how many deaths per year are due to sepsis?

A

1/5 of all deaths globally

21
Q

how many deaths in children per year?

A

3 millions death per year for children <5

22
Q

prevention of sepsis?

A
  • hand hygiene
  • clean environment
  • safe water and sanitation
  • infection, prevention and control programmes
23
Q

how can the evolution of sepsis be prevented?

A

1- early detection of sepsis signs an symptoms
2- prompts seeking of medical care
3- promo antimicrobial treatment and its reassessment

24
Q

what are the 3 different types of sepsis?

A

1- bacterial sepsis
2- viral sepsis
3- fungal sepsis

25
Q

bacterial sepsis?

A

excessive amounts of normal pro-inflammatory antibacterial signalling
- responds to antibiotics
- most common

26
Q

viral sepsis?

A
  • often contracted outside the hospital
  • largest risk factor is age and prematurity
  • least common
27
Q

fungal sepsis?

A
  • highest mortality rate
  • exclusively contracted in the hospital
  • severe CNS effects
28
Q

what 2 things should you consider when looking at the presentation of sepsis?

A

1- localising symptoms or signs that point to the underlying cause
2- general symptoms or signs that reflect on the severity of sepsis (informing triage)

29
Q

what are the 3 main things measured in qSOFA?

A

1- altered mental status <15
2- fast respiratory rate >22
3- low blood pressure <100

30
Q

management of sepsis, rationale and overview?

A

1- resuscitation (ABC DE)
2- early antibiotic
3- triage to appropriate place of care

31
Q

what blood tests should you do?

A

FBC
U&E
LFT
CRP
lactate

32
Q

what is a high lactate a sign of?

A

hypo perfusion in sepsis - a high lactate Is associated with a high mortality
- if lactate is >4 repeat at 4-6hrs

33
Q

blood culture?

A
  • minimum of one set of optimally filled blood cultures ideally before antibiotics but should not delay antibiotic treatment
  • consider source and source control
34
Q

what antibiotics should be given?

A

IV amoxicillin + metronidazole + gentamicin.

if allergic to penicillin give:
IV vancomycin + metronidazole + gentamicin

35
Q

what is the fluid challenge?

A
  • give a set volume over a period of time (in doses)
  • prescribe 250-500ml of fluid
36
Q

what is the difference between aggressive and excessive fluids?

A

aggressive fluids = this will maintain perfusion requirements to vital organs and mitigate shock
excessive fluids = precipitate pulmonary oedema, respiratory failure an will complicate treatment

37
Q

what is a sign of effective urine output?

A

0.5mls/kg/hr

38
Q

if origin of sepsis is unknown what kind of antibiotics do you give?

A

broad spectrum

39
Q

describe ‘golden hour’?

A
  • early recognition
  • early stratification
  • early antibiotics
  • specific goals
  • triage of care
  • handover (SBAR)

MD3001 (56 decks)

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