sepsis Flashcards
What are the warning signs of sepsis
Slurred speech or confusion Extreme shivering or muscle pain Passing no urine (in a day) Severe breathlessness "I feel like I might die" Skin mottled or discoloured
Why can it be difficult to spot?
sometimes, it can be very obvious that a patient has low bp and high temperature.
And patients might breathe rapidly and have a racing pulse, for example.
-But early on, all these symptoms can be MISTAKEN for influenza or other infections.
why is the diagnosis of sepsis is a huge worry for GPs?
initial symptoms can be very similar to common viral illnesses
candida is larger than a bacteria…T/F? why
yes, its is a yeast
what is bacteraemia? septicaemia?
- presence of bacteria in the blood
- outdates clinical term meaning generalised sepsis
what urgent investigation can u perform? and why?
- full blood count> check for neutrophils
- blood sugar
- coagulation clotting factors
- liver function
- CRP > marker of inflammation
- blood gases
- CSF
- urea & electrolytes> septic ppl can have renal failure
- blood cultures> confirm and identify the bacteria causing the infection.
- imaging> look for abdominol X-ray or CT to look for pathology related Tumor.
life threatening complication?
- kidney acute injury (renal failure)
- hypotension irreversible
- inter cranial pressure
- respiratory failure
- necrosis of digits/hands/feet
explain how sepsis leads to a reduction in blood pressure? & explain how the patient becomes tachycardiac?
inflammatory response causes cytokines to be released and cause vasodilatation.
endotoxins (LPS) r the most potent stimulators of cytokine release.
Tachycardia occurs due to body compensating. but this compensation own be effective enough to solve the problem.
Which immune cell recognises the bacterial pathogen?
Which component of the bacteria is most important in triggering a reaction from this immune cell?
n
Name some of the molecules (mediators) produced by this immune cell in response to the pathogen
n
Where is CRP produced (i.e. which organ)?
What triggers this organ to produce CRP and other proteins?
How quickly is CRP produced?
Why is CRP measurement useful in clinical practice?
What is the function of CRP?
Can the CRP level help to identify the bacteria or the correct treatment?
- liver
- when inflammation is high, macrophages r present in high amounts in the blood!> they produce CYTOKINES (iL-6 & il-1B) that will go to the liver & tell hepatocytes to make more CRP (making it a marker of inflammation)
- a few HOURS to be produced and measured in blood
- if raised, useful indicator that inflammation is there (but not specific)
***it binds to phophocoline expressed on the surface of dead bacterial cells and some bacteria, this activates the complement system promoting phagocytosis by macrophages.
The production of CRP is part of the “Acute Phase Response”. Name one other important feature of the acute phase response (also triggered by the substances produced by the immune cell).
n
What is sepsis? what is a septic shock?
- Serious life-threatening response to infection
- persisting hypotension
Why should u be careful when u want to consider doing a lumbar puncture to a septic patient?
a septic patient could have a raised intracranial pressure, if we take a CSF in lumbar region, & reduce the pressure there, this might allow the brain to suck down & the base of the brain can be stuck at the top of the spinal cord
Why can some patient represent with high lactate during infection? how will they appear clinically?
Body starts to undergo metabolism anerobically, and this produces lactic acid, which can cause lactic acidosis.
-hyperventilate to release excess Co2
how do u develop fever?
macrophages produce cytokines (TNF,IL-1) increase prostaglandin E2 w/ in the anterior hypothalamus.
pathophysiology of sepsis
endotoxin “within” the bacterial cell binds to macrophages, increased level of cytokines r released into circulation causing probs (TNF-; IL-1)
why does the patient develop tachypnea? explain
patient is getting a systemic inflammatory response, they start to develop HYPOtension>they develop metabolic acidosis> compensation would be to breath fast to release co2
what is acute phase proteins? & give an example
there r a variety of proteins floating in the serum that r involved in the development of the immune response,
These proteins increase during an infection! & r called “acute phase proteins”
-CRP acts as an opsonin (called bc it binds to the c-molecule of pneumonococci, which promotes their phagocytosis)
what is CRP?
acute phase protein raised during an inflammatory response
we perform a lumbar puncture of a patient and take the CSF sample to the lab.
what r we looking for?
its very specific.
which organism is causing the infection and also which STRAIN. (gram stain -or+)
- look for protein and glucose,wbc, rbi
function of pili on bacteria?
hairlike structure
enhace attatchment on host cell
they r important Virulence factors!
what is the sepsis six?
name given to a bundle of medical therapies designed to reduce the mortality of patients with sepsis
1) respiratory rate
2) O2 saturations
3) temp
4) systolic BP
5) pulse rate
6) level of consciousness
what is the purpuric rash?
during the glass tumbler test, u press against the skin with a glass, the red spots on the skin will not blanche (like it would normally do) in this case, it’ll stay red.»
what is E coli
normal flora of the gut
what r the 3 virulence factors?
endoxin
capsule
pili
which antibiotic do u give in sepsis during an emergency? what should u take under consideration when choosing it? and in what form do u administer it? why?
we should not give it orally,
we want it to get into the site of infection as well (must penetrate in the CSF)
CEFTRIAXONE
how do u diagnose for N.meningitis?
throat swab
what is the purpose of the glass tumbler test? how is it performed
during the glass tumbler test, u press against the skin with a glass, the red spots on the skin will not blanche, it’ll stay red.
this is believed to be caused by the presence of N-meningicoccus
what is included in the sepsis 6 bundle and describe each?
1) Give oxygen
2) blood culture
3) IV antiobiotics (only after taken blood culture)
4) fluid challenge
5) lactate> measure of disturbed metabolism
6) urine output> tell u about kidney function
