Sepsis Flashcards
What does SIRS stand for?
systemic inflammatory response syndrome
The development of septic shock
SIRS = temp, HR, RR, WBCs
Sepsis = SIRS + infection
Severe sepsis = sepsis + end organ damage
Septic shock = severe sepsis + hypotension
What scoring system is used to identify sepsis
qSOFA, then SOFA (sepsis related organ failure assessment)
qSOFA =
- hypotension systolic <100
- tachypnoea - RR 22
- altered mental states GCS <15
SOFA =
- PaO2/FiO2 ratio
- GCS
- MAP
- Vasopressors
- creatinine/output
- Bilirubin
- Platelet count
if 2 or more then admit to ICU
hospital mortality rate of patients with septic shock
40%
3 phases in the pathogenesis of sepsis
- release of bacterial toxin
- release of mediators
- effects of specific excessive mediators
Types of bacterial toxin
gram negative - LPS
gram positive - superantigens and MAMPs
Types of mediators
Th1 and Th2
Mediator responses
Pro-inflammatory - vasodilate, produce arachidonic acid, hyperthermia, increase coagulation
Anti-inflammatory - inhibit TNF alpha, inhibit coagulation factors, provide negative feedback to pro-inflammatory markers
When does septic shock happen in regard to the balance between the pro and anti-inflammatory mediators?
when pro-inflammatory markers outweigh the anti-inflammatory markers. Immunoparalysis occurs when it is the other way round
Clinical features of sepsis - general groups (5)
general organs inflammatory haemodynamic tissue perfusion
General features of sepsis (6)
Fever >38 Hypothermia <36 - especially in the elderly Tachcardia >90bpm Tachypnoea>20/min Altered mental status Hyperglycaemia
Organ features of sepsis (5)
Brain - altered consciousness, confusion, psychosis
Lungs - tachypnoea, sats <90%
Liver - increased liver enzymes, decrease albumin, increase PT, hyperbilirubinaemia
Heart - hypotension, tachycardia
Kidneys - oligouria
Inflammatory features of sepsis (5)
Leucocytosis - >12,00 Leucopenia- <4000 Normal WCC with greater than 10% immature forms (high turnover) High CRP High procalcitonin
Haemodynamic features of sepsis (2)
Arterial hypotension
Sv02 >70%
Tissue perfusion factors (3)
high lactate
skin mottling
reduced capillary refill
Effect of host on sepsis presentation (4)
- age
- co-morbidities (COPD, diabetes, CFF, malignancy)
- Immunosuppression (acquired, drug induced, congenital)
Sepsis 6
Take 3: blood culture (if spike in temp do 2 sets), blood lactate (more supportive biomarker of outcome), urine output
Give 3:
O2, IV antibiotics, IV fluid
(2 A,B,Cs)
When to consider HDU?
Low BP responsive to fluids Lactate >/ 2 despite fluid resuscitation elevated creatinine Oligouria Liver dysfunction Bilateral infiltrates§
When to consider ITU?
SOFA >/2
