Sepsis Flashcards
Define, diagnose, and manage sepsis effectively
Definition of sepsis.
Life threatening organ dysfunction caused by a dysregulated host response to infection.
It occurs when the body’s immune system overreacts to infection. The body’s immune system goes into overdrive, setting off a series of reactions that can lead to widespread inflammation (swelling) and blood clotting.
Cytokine storm due to overwhelming infection → systemic inflammatory response syndrome (SIRS) → vasodilation, increased vascular permeability, and hypotension.
Risk factors of sepsis
Think ‘could this be sepsis’ in everyone with ? infective picture
Intrinsic demographic risk factors, medical history, social history
- Neonates, pregnant women, older people (over 75 years), or frail people
- Immunosuppression (illness e.g. diabetes, AIDS, drugs e.g. immunosuppressant therapy, steroids)
- Surgery or invasive procedures, in the past 6 weeks, including obstetric events
- Breach of skin integrity (for example, cuts, burns, blisters or skin infections)
- IV drug users
- Indwelling lines or catheters.
Diagnosis of sepsis.
When there is a confirmed diagnosis of an infection and a SIRS (≥2 in temperature changes, increased HR, respiratory changes, WBC changes)
Based on:
* History and presentation — GP, ED, ward
* Clinical signs
* NEWS2
* Further investigations – FBC, blood cultures, lactate levels, organ function tests
https://www.mdcalc.com/calc/1096/sirs-sepsis-septic-shock-criteria#next-steps
What are some common signs and symptoms of sepsis?
- Fever (but not always)
- Chills and rigours
- Malaise, dizziness (hypotension)
- Nausea and vomiting
- Respiratory distress: Tachycardia and tachypnoea (SOB)
- Decreased urine output - when did they last pass urine?
- Other symptoms of infection e.g. cough, myalgia, abdominal pain, dysuria, breaches in skin integrity
What are some clinical signs that may indicate severe sepsis?
With identified/suspected source of infection
- Mottled skin
- Pallor and cyanosis (skin, lips, tongue)
- Prolonged capillary refill time
- Non-blanching petechial or purpuric rash
In addition to vital signs derangement e.g. tachycardia, tachypnoea, fever, confusion, hypotension
Suspected sepsis
If someone presents without a confirmed infection and is supected to have sepsis (SIRS present/abnormal vital signs), how would you further investigate for infection?
e.g. Examination, bedside tests, bloods, imaging
Physical Examination: Look for signs of infection, such as redness, swelling, or discharge.
Bedside tests e.g. urinalysis, swabs.
Blood tests
* Blood Tests: FBC, clotting, UnE, creatinine, LFT
* Blood gases: SpO2, SpCO2, Lactate Levels:
Blood Cultures (for bacteraemia)
Other Cultures: Urine, wound, and respiratory secretions.
Imaging:
* Chest X-rays
* Ultrasound: To detect infections in the gallbladder, kidneys, or other organs.
* CT Scans: To identify infections in the abdomen or other areas.
MRI: For detailed images of soft tissues and bones.
Culture-negative sepsis: blood culture is negative (X bacteraemia)
What is the immediate management of sepsis? (Sepsis 6)
Used within 1 hour of diagnosis of sepsis
- Ensure Oxygen 94-98%
- Blood cultures
- IV broad-spectrum antibiotics — may depend on risk and clinical judgement to avoid related harms
- Fluid resuscitation (500 mL of crystalloid, with sodium in the range 130 to 154 mmol/L (130 to 154 mEq/L), over less than 15 minutes, if either lactate is over 2 mmol/L or systolic blood pressure is less than 90 mmHg)
- Lactate levels monitoring
- Urine output monitoring
How is the NEWS2 score used in sepsis diagnosis and management?
Used as a risk assessment and tool to gauge the response to treatment
What are 3 things in a NEWS2 chart that may indicate sepsis or a poorer prognosis of sepsis?
i.e. severe illness or death by sepsis
- Aggregate score (5 or above - moderate risk; 7 - high risk of severe illness/death)
- Score in each parameter (A score of 3 in any single parameter )
- Trend (Increased risk if contintually deteriorating despite intervention)
These require increased monitoring frequency: minimum 1 hourly;
Source: clinical response to the NEWS trigger thresholds
https://www.bmj.com/content/385/bmj.q1173
On which patients may the NEWS2 score be unreliable or more severe than clinically?
Patients with altered baseline physiology (eg, spinal injury, heart, and lung disease)
Take these in consideration!
What are the major life-threatening complications of sepsis?
Think 3 categories
Septic shock,
DIC, and
organ dysfunction e.g. ARDS, AKI, type 2 MI, and multiple organ dysfunction syndrome (MODS)
Definition of septic shock. What is the underlying pathophysiology?
Severe sepsis AND haemodynamic instability – hypotension despite adequate fluid resuscitation.
Pathophysiology: cytokine storm (TNFa, IL1, IL6 etc.) causes widespread inflammation, increased vascular permeability, losses of vascular tone leading to vasodilation/inability to maintain BP despite fluid input
Pathophysiology of organ failure in sepsis.
Generally, organ failure (secondary to tissue damage) is caused by septic shock, inflammatory processes, widespread bleeding/clotting i.e. DIC and causes hypotension, which results in shock — inadequate supply (O2, nutrients, remove waste) and end-organ damage.
What factors in sepsis impair oxygen uptake?
List 4
- Pulmonary oedema/Acute Respiratory Distress Syndrome (ARDS): Septic shock and widespread inflammation causes increased permeability of the alveolar-capillary membrane and leading to fluid accumulation in the lungs.
- Pneumonia/chest infection
- Microvascular Thrombosis in pulmonary circulation.
- Hypoperfusion and Organ Dysfunction secondary to septic shock/ tissue hypoxia.
Which organs are most commonly affected in sepsis?
Kidneys (hence monitor urine output),
lungs (dropping O2 sats, respiratory distress, cyanosis),
liver, and
heart.
