Sepsis

Question 1

What is Sepsis ?

Answer 1

a systemic inflammatory response to a documented or suspected infection
- a whole body response to the microorganism is exaggerated
- vasodilation & capillary permeability of blood flow (widening of the blood vessels which decreases BP and decreases perfusion to all vital organs)
- coagulation increases

Question 2

What are some examples that could cause sepsis ?

Answer 2

INFECTIONS
- pneumonia
- peritonitis
- UTIs
- procedures
- indwelling devices (foleys, central lines)

Question 3

Which people are at risk for getting sepsis ?

Answer 3

• young (under 10) or old (over 65)
• pt’s with chronic diseases (diabetes, kidney/liver disease, etc)
• recent surgery
• severe burns/wounds
• pt on immunosuppressive therapy (COPD, Crohn’s)
• pt’s who are malnourished
• postpartum (pregnant and immediate pp pt’s are naturally immunocompromised): immune response is decreased to prevent fetal rejection

Question 4

How does sepsis affect the cardiovascular-peripheral vascular system ?

Answer 4

• cardiac output and BP are initially maintained due to kidneys maintaining vasoconstriction & fluid balance
• eventually vasodilation and capillary permeability cause:
  
  • Low cardiac output and BP
  • tachycardia
  • weak peripheral pulses
  • edema
• later it can cause tissue ischemia (tissue dies because of no perfusion), & myocardial ischemia/infarction (MI)

Question 5

How does sepsis affect the respiratory system ?

Answer 5

initially, decreased blood supply & increased metabolic rate cases fast breathing
- with inflammation & increased capillary permeability we see fluid leaking from the vasculature
- infiltrates
- alveolar edema
- you will hear crackles
- eventually respiratory failure will occur

Question 6

How does Sepsis affect the progressive phase in the renal system ?

Answer 6

• decreased urine output
• elevated Blood Urea Nitrogen (BUN) & Creatinine
• Anuria/need for dialysis
  A foley is important to get accurate I&O’s every hour

Question 7

How did Sepsis affect the compensatory phase in the renal system ?

Answer 7

• there is decreased perfusion, and it activates the Renin Angiotensin system which then causes vasoconstriction
• Angiotensin II, Aldosterone, Na & H2O reabsorption, and Anti-Diuretic Hormone (ADH) all help maintain cardiac output and BP

Question 8

How does sepsis affect the GI system ?

Answer 8

• decreased blood flow causes decreased bowel sounds
• risk for ileus (bowels or intestines just completely stop)
• ulcers (poor perfusion causes thinned mucus lining that usually protects), bleeding, impaired absorption
• ischemic gut, & necrosis

Question 9

How does sepsis affect the skin ?

Answer 9

decreased blood flow causes cyanosis, and cool skin

Question 10

How does sepsis affect the neurologic system ?

Answer 10

Poor perfusion of the brain leads to:
- altered mental status (AMS)
Eventually,:
- unresponsive, Areflexia (absence of deep tendon reflexes)
- pupils nonreactive
- older adults may become confused very quickly
- younger adults/children may exhibit no mental status changes, until they become less responsive or lose consciousness

Question 11

How does sepsis affect the hematologic system ?

Answer 11

Disseminated Intravascular Coagulation (DIC)
- doesn’t occur in everyone
- thrombin clots in microcirculation
- platelets are consumed making unnecessary small clots, so they are not available to help clot where needed (bleeding)
- clotting and bleeding at the same time
- may have petechiae or purpura (big purple splotches)
- urine may look pink or gums may bleed (varies)

Question 12

What is some treatment for Sepsis ?

Answer 12

• supplemental O2 (mechanical ventilation)
• FLUIDS (30 mL/kg), Crystalloid/isotonic (NS/LR)
• when fluids don’t work then vasopressors (this constricts blood vessels everywhere so it can cause neurotic tissue & need critical care)
• Norepinephrine (levophed)
• or corticosteroids (stop inflammatory response), albumin (if problem with fluid shift), inotropes in increase the heart’s contractility

Question 13

How do you monitor for effectiveness of sepsis ?

Answer 13

• O2 saturation, arterial blood gas
• BP (central venous monitoring, manual automatic)
• urine output
• mental status
• peripheral pulses
• Goal for MAP is > 65

Question 14

How do we know how much fluid to give a septic pt ?

Answer 14

30 mL/kg about 1.5 to 3 L of fluid

Question 15

What is some GI treatment for sepsis ?

Answer 15

• enteral or parenteral if needed
• enteral may help stimulate the GI tract & prevent ileus, maintain mucosa
• PPIs to decrease risk of ulcers
  
  • pantoprazole, esomeprazole,
    lansoprazole

Question 16

What is some Genitourinary/renal treatment for sepsis ?

Answer 16

• IV fluids (30mL/kg)
• diuretics (furosemide/lasix)
• dialysis
• monitor BUN, creatinine, & electrolytes

Question 17

What is the general treatment for sepsis ?

Answer 17

• antibiotics within the 1st hour
• try to get cultures first so that the antibiotics don’t kill off all the bacteria before you can get the culture
• broad spectrum at first and then targeted
• vancomycin and piperacillin are the most common

Question 18

What is the treatment for disseminated intravascular coagulation (DIC) ?

Answer 18

platelet transfusion
- difficult to anticoagulate due to risk for bleeding