SEPSIS Flashcards
define sepsis/septic shock/ multiorgan failure
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection.
The new guidelines recognise the following terms:
sepsis: life-threatening organ dysfunction caused by a dysregulated host response to infection
septic shock: a more severe form sepsis, technically defined as ‘in which circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone’*
The old category of severe sepsis is no longer used.
The term ‘systemic inflammatory response syndrome (SIRS)’ has also fallen out of favour.
Adult patients outside of ICU with suspected infection are identified as being at heightened risk of mortality if they have quickSOFA (qSOFA) score meeting >= 2 of the following criteria: respiratory rate of 22/min or greater, altered mentation, or systolic blood pressure of 100mmHg or less
MODS
= impairment of 2 or more organ systems
homeostasis cannot be maintained w/o therapeutic intervention
mx: risk stratification
NICE released their own guidelines in 2016. These focussed on the risk stratification and management of patients with suspected.
For risk stratification NICE recommend using the following criteria:
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Clearly the underlying cause of the patients sepsis needs to be identified and treated and the patient supported regardless of the cause or severity.
If however any of the red flags are present the ‘sepsis six’ should be started straight away: OBAFLO
- Administer oxygen: Aim to keep saturations > 94% (88-92% if at risk of CO2 retention e.g. COPD)
- Take blood cultures
- Give broad spectrum antibiotics
- Give intravenous fluid challenges: NICE recommend a bolus of 500ml crystalloid over less than 15 minutes
- Measure serum lactate
- Measure accurate hourly urine output
*these patients can be clinically identified by a vasopressor requirement to maintain a MAP ≥ 65mmHg and serum lactate >2mmol/L in the absence of hypovolemia
