Sepsis Flashcards
If you suspect someone has sepsis what can you use to determine whether they do or dont?
Sepsis bundle
What is the management of sepsis?
History
Examination (as quickly as possible to determine whether there is sepsis)
Investigations-blood tests etc-where is the infection, what is the infection
This will lead to treatment
What is rigor?
Sudden attack of sever shivering accompanied by feeling of coldness (associated with a marked rise in body temp
How can you test whether a purpuric rash is blanching or non blanching?
Glass tumbler test
When you press against the skin with a glass and it doesnt change colour - non blanching (important warning sign)
Normal red spots should disappear with the glass tumbler test
What is sepsis?
Sepsis is life threatening organ dysfunction due to a dysregulated host response to infection
Serious life threatening response to infection
What is septic shock?
Septic shock is persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation.
What is bacteraemia?
The presence of bacteria in the blood can have clinical feature but can also be undetected and not harmful
What do you do if you think someone has sepsis?
Assess patient using EWS chart (give patient an early warning score)
Looks at; Temp, resp rate, blood pressure, heart rate, consciousness
EWS >3 (or =3) they are at risk and are monitored for sepsis (considered and reviewed for sepsis)
Look at clinical features suggesting source (eg pneumonia, UTI, meningitis etc)
Check for red flags (eg high RR, low BP, unresponsive)
If a patient has a red flag for sepsis, what must be done?
Immediate action
Inform senior doctor for review
Send urgent investigations
Complete sepsis six bundle
What is the sepsis six bundle and how quickly should it be completed?
Give; oxygen IV antibiotics (AFTER BLOODS ARE TAKEN) Fluid challenge - raise BP
Take; blood cultures (BEFORE ANTIBIOTICS ARE GIVEN)
Measure lactate (measure of disturbed metabolism
Measure urine output
What sort of urgent investigations need to be done if someone is suspected of having sepsis?
- Full blood count (raised or lowere WC count, looking at platelet count), U&Es (renal function)
- EDTA bottle for PCR
- Blood sugar
- Liver function tests
- CRP(good inflammatory marker)
- Coagulation studies (clotting is dramatically disturbed with sepsis)
- Blood gases
- Other microbiology samples (CSF, urine etc)
How do endotoxins cause endotoxins (the inflammatory cascade) sepsis?
Endotoxins bind to macrophages
Local; cytokines (reduced by macrophages), tissue necrosis factories and interleukins (TNF & IL-1)
Stimulate inflammatory response to promote wound replace and recruit recruit RE (reticuloendothelial) system
System; cytokines (promote clotting) are released into circulation.
Stimulate Growth factor, macrophages and platelets.
Goal is control the infection.
SEPSIS; infection NOT controlled
Cytokines lead to activation of humoral cascades and RE system; CIRCULATORY INSULT (organ injury)
How can coagulation caused by cytokines lead to sepsis? What can also occur?
Cytokines initiates production of thrombin and this promote coagulation
Cytokines also inhibit fibrinolysis
Coagulation cascade leads to microvascular thrombosis
Leads to organ ischaemia, dysfunction and failure
SEPSIS + necrosis (gangrene)
**microvascular injury is the major cause of shock and multiorgan failure
What is the treatment for sepsis?
Supportive is more important because need to prevent further problems and further organs failure
(Need to look at Symptom relief and physiological restoration)
Supportive care; consider referral to ITU, sepsis six bundle, regular monitoring and reassessment
Specific treatment - antibodies broad but specific enough until you know exactly what you’re dealing with (after blood is taken). Need an antibody that can access the site of infection and drainage of pus
How does sepsis lead to a reduction in blood pressure?
Get decreased blood volume which decreased TPR because cells are moving out of the blood
