sepsis Flashcards
what is it?
Sepsis is defined as a syndrome of life-threatening organ dysfunction due to a dysregulated host response to infection.
Septic shock is another term used to describe some patients with sepsis who are at greater risk of death. To be classified as having septic shock, patients need to be persistently hypotensive, requiring vasopressors to maintain a mean arterial pressure of 65 mmHg or more and have a lactate of over 2 mmol/L despite adequate fluid resuscitation.
what is the aetiology?
The commonest sources of infection are respiratory, genitourinary, renal and gastrointestinal
Most causative pathogens are bacteria, although fungal, parasitic and viral infections can also lead to sepsis
The commonest organisms identified are Staphylococcus aureus, Escherichia coli and Pseudomonas species
what are RF?
Pregnancy
Recent miscarriage or abortion
Frailty
Immunocompromise due to chronic comorbidities e.g. HIV, diabetes, sickle cell disease
Immunosuppression secondary to medications e.g. chemotherapy, steroids
Recent surgery or trauma
Skin breaks or infections
Drug or alcohol misuse
Indwelling lines or catheters
what re features?
General malaise
Fevers, sweats or chills
Localising signs of infection e.g. rashes, dysuria
Decreased urine output
Confusion
Breathlessness
Nausea and vomiting
Myalgia
Tachycardia
Hypotension
Pyrexia or hypothermia
Dehydration e.g. dry mucous membranes
Altered mental state including delirium
Irritability
Respiratory distress e.g. tachypnoea, accessory muscle usage
Cyanosis and hypoxia
Delayed capillary refill time
Cool extremities
Skin appears mottled or ashen
what are ix?
think SEPSIS SIX - take 3, give 3
Blood cultures ideally prior to antibiotic administration
Lactate (i.e. a blood gas - venous or arterial)
Urine output (which may involve inserting a urinary catheter)
Capillary blood glucose
Urine pregnancy test
Urine dip and send for MC&S
ECG
FBC, CRP, U+Es, LFTs, coag
CXR
what is the mx?
think SEPSIS SIX - take 3, give 3
IV fluid resuscitation (usually a 500ml bolus over 15 minutes initially)
Supplementary oxygen to target saturations of 94-98%
Broad-spectrum IV antibiotics
Close monitoring of observations, fluid balance, clinical condition and bloods including serial lactate measurement
Source control, e.g. draining abscesses or debriding infected tissue
Infected devices may need to be removed
what are complications?
multi-organ failure
coagulopathy eg DIC
delirium
mental health impacts
polyneuropathy
death
