SEPSIS Flashcards
What is sepsis
Life threatening organ dysfunction due to dysregulated host response to infection
SIRS / qSOFA + evidence of infection
SIRS now not really used
What is septic shock
Sepsis +
Persisting hypotension requiring vasopressors to maintain MAP >65 (hypo after 20ml/kg fluid)
or BP <90 or <40 below normal
Serum lactate >2mm (anaerobic respiration due to hypo-perfusion)
What is SIRS
2 of: Hypo / hyperthermia Tachycardia Tachypnooea PaCO2 <32 WBC <4000 or >12000 Altered mental state BG >7.7 with DM Sats <90 or PaO2 <70
What causes SIRS
Sepsis
Bruns
Pancreatitis
Trauma
What do you do if evidence of infection + 2+ qSOFA
SEPSIS 6
Assess frequently in 1st house
Look for septic shock / end organ dysfunction
What are red flags (Start sepsis 6)
Responding only to pain or voice Acute confusion SBP <90 HR >130 RR >25 O2 <92 Non-blanching / rash / mottled / cyanosis Not passed urine 18 hours Lactate >2 even if apyrexial Chemotherapy
What are RF for sepsis
Any condition that impacts on the immune system Age Co-morbid - COPD / DM Immunosuppresion - chemo / steroids Previous surgery / recent trauma e.g. burns Pregnancy Indwelling medical devices Virulence of organism Occupation Travel Hospital
What is qSOFA
Hypotension <100 or <40 below normal
Altered mental status
Tachypnoea >22
What is SEPSIS 6
WIRHIN 1 hour
Blood culture (2 sets A+An)
Blood lactate + bloods (easiest with VBG or ABG)
Urine output / catheter to get hourly urine output
Oxygen - 94-98%
IV Antibiotics
IV fluid
Inotropes / vasopressor in ITU if needed if BP is not responding
When should you do blood cultures
Fever Hypothermia Leucocytosis Neutropenia Unexplained organ dysfunction
What do you send lab tests of as
Emergency
Get results in 1 hour
How much fluid
Bolus 500ml over 15 minus
What Ax do you give
Cephalosporin + amox
Add vancomycin if resistant
Add metronidazole if GI
What is mortality from sepsis and septic shock
Sepsis - 10%
Septic shock - 40%
Mortality increases by 7.6% for each delay
What has different protocol
Neutropenic sepsis
What do you get ASAP
Senior input
When do you go to HDU
Low BP even with fluid High lactate >2 with fluid Increased creatinine Oliguria Liver dysfunction Bilateral. infiltrates
How do you get into ITU
Septic shock requiring vasopressor
Multi-organ failure
Incubation required
What are signs of end organ dysfunction / severe sepsis
Arterial hypoxaemia Hyptension BP <90 / MAP <65 Lactate >2 Oliguria <0.5ml/kg/hr for 2 hours AKI Coag abnormalities - raised PT / APTT Thrombocytopenia Hyperbilirubin Paralytic ileus Confusion as brain not perfused
What are inflammatory variables
Leucocytosis Leucopenia Normal WCC High CRP High procalcitonin
What are haemodynamic variables
Arterial hypotension
SvO2 >70%
Sats <90%
What shows poor perfusion
High lactate
Reduce perfusion
SKin mottling
What are signs of systemically unwell
N+V
Rigors
Poor appetite
What do you do if vomiting
U+E
ECG
AXR if think obstruction
