Sepsis Flashcards
define sepsis
life-threatening organ dysfunction caused by dysregulated host response to infection
define colonisation
presence of microbe in human body without inflam response
define infection
inflam due to microbe
define bacteraemia
presence of viable bacteria in blood
what is the 2016 consensus definition of septic shock
persisting MAP<65 & lactate>2 despite euvolemia (adequate fluid resuscitation)
what infections are enteroccous streptococci associated with
gut commensal, UTI
define septicaemia
“booby trap for exams”
in which patients might you suspect a biofilm
prosthetic, CF, bronchiectasis
what sequence of events cause metabolic acidosis in sepsis
hypotension > hypoperfusion > hypoxia > anaerobic metabolism > lactic acid accumulation
what causes hypotension in sepsis
toxins stimulate TNFa to produce vasodilator NO and cause endothelial damage leading to leakiness
how is sepsis screened for
qSOFA, NEWS, SIRS, NICE
what is the general presentation of sepsis
pyrexic, pale/cold/clammy, muscle ache, confusion
what is required for a diagnosis of sepsis
NEWS2 >5 and suspected infection
what is the problem with SIRS
screens non-specific inflam not just infection
what are criteria for SIRS
2 of temp >36 / <38 HR >90 RR >20 WBC <4 / > 12 / 10% immature neutrophils confused
what is the sepsis 6
oxygen fluids blood culture and other cultures IV empirical antibiotics lactate, FBC & biochemistry monitor urine output
what are the target oxygen saturations
target 94-98% unless COPD/severe sepsis
what fluid should be give
500ml bolus 0.9% sodium chloride
what is an alternative fluid regimen
Hartmann’s solution
what type of fluids are sodium chloride and Hartmann’s solution
crystalloids
what fluid should never be given for sepsis
5% dextrose
what should be done after giving 500ml of 0.9% NaCl
reassess HR, BP, RR, UO and repeat bolus until normal
what drugs should be considered for hypotension despite euvolaemia (aka septic shock)
inotrope / vasoconstrictor e.g. noradrenaline via a central venous catheter
what MAP are you aiming for in hypotension management
> 65
what MAP are you aiming for in hypotension management
> 65
in what scenario should you give antibiotics before culture
purpura fulminans
what should be done after the microbiology result for antibiotic stewardship
stop, PO switch, change to narrow-spectrum, review after 24hr
what other blood tests should be done that aren’t included in sepsis 6
Hb, CRP, creatinine, clotting screen, ABG, bilirubin, LFTs
what is a normal serum lactate and does an elevated lactate suggest
normal <1.8, suggests hypoperfusion/hypoxia
what options are there or measuring urine output
record volume or catheterise for hourly volumes
when should you catheterise the patient
if urine output <60ml after 2 hours
what is qSOFA used for
abbreviated version of SOFA, prognostic indicator
what are the criteria for qSOFA
RR>22, sBP<100, altered GCS
what time of oedema is a complication of sepsis
non-cardiogenic pulmonary oedema
what is the incubation period
time between encountering bug and symptom onset
what is the prodromal period
early signs of symptoms before actual signs
what is DIC
disseminated intravascular coagulation, comp of sepsis
what is the red flag for acute kidney injury in sepsis
oligurea
what is the management of pyomyositis
urgent surgical debridement + 6wk IV ABx
what is a complication of pyomyositis
septic emboli caused pneumonia and endocarditis
