Sepsis Flashcards
What is SIRS?
A systemic inflammatory response syndrome - response to (non)infective insult to the body. Syndrome of deregulated inflammation - physiological repair foes into overdrive and becomes pathological.
What is sepsis?
Syndrome of life threatning organ dysfunction due to a deregulated host response to infection. SIRS with evidence of infection causes inflammation
What is septic shock?
Brnach of sepsis - circulatory, metabolic and cellular abnormalities associated with a greater risk of mortality that sepsis.
Sepsis with hypoTN despite fluid correction and inotropes - requiring vasopressors to maintain a MAP of >65mmHg and hyperlactemia serum lactate >2mmol/L.
What clinical signs define SIRS?
Having two or more of:
Temp >38.5 or <36
Heart rate >90 bpm
RR >20bpm
WCC >12 or <4x10^9 cells per L
Altered mental status
Capillary glucose >7.7mmol/L
What red flags raise the suspicion of Sepsis?
HR >130
RR >25
SBP <90
GCS <A
What is the use of the qSOFA score in sepsis?
Score of 2 or more criteria suggests a greater risk of a poor outcome - predict mortality
RR >22/min
SBP <100mmHg
GCS <15
What BP is considered to be clinical shock in septic shock?
BP <90mmHg
Causes severe hypo-perfusion and must be aggressively managed
Often has signs of oran dysfunction
What are the different criteria from a NEWS score that could indicate sepsis?
Score of 3+ in one parameter and known/suggestive infection
Combined total score of 5+ and known/suggestive infection
Consider sepsis and escalate immediately
What are the red flags for sepsis that require urgent escalation?
New or altered mental status
Systolic BP <90mmHg or drop of >40
HR >130bpm
RR > 25
Needs O2 to maintain >92% or 88% in COPD
Non-blanching rash, mottled, ashen, cyanotic
Recent chemo
Not passed urine in 18 hrs.
Children - doesn’t wake when roused or wont stay awake.
What is the management for suspected sepsis?
- Give high flow oxygen - maintain sats at >95%
- Give IV broad spectrum antibiotics - trust protocol, readjust to causative organisms and susceptibility
- Give IV fluids challenge - if SBP <100 500ml Hartmans over 15 mins, is >100 250ml Hartmans over 1 hr
- Blood cultures - consider imaging, sputum, urine etc
- Measure serum lactate and Hb
- Measure accurate urine output - catheterization and start a fluid balance chart.
What is the mortality rates for sepsis?
Sepsis = 10%
Severe sepsis - evidence of organ dysfunction = 35%
Septic shock = 50%
When should antibiotics be started in sepsis?
Immediately if a senior clinicians makes a suspected sepsis diagnosis.
This should be before pathogen identification but after blood cultures have been taken
IDeally within 1hr for initial NEWS7 or above
Or within 3 hours for a news of 5/6.
What patients are at a higher risk of sepsis?
Chronic diseases (HIV, COPD, cancer)
Immunosuppression
Prior organ dysfunction
Recent surgery or invasive procedure in past 6w
Delay in diagnosis and treatment
The very young <1yr
>75yrs and very frail
Pregnant or post partum (inc miscarriage) in past 6w.
IV drug users
Indwelling lines/catheters
Why is early management and diagnosis of sepsis important?
Risk of death from sepsis increases by as much as 8% for every hour.
What are the most common sources of sepsis?
Pneumonia 50%
Intra-abdominal 15-20%
UTI - 25%
