Sepsis Flashcards
Types of infection
Bacterial, fungal, parasitic, viral
Infection emergency
Cause adverse outcome to patient
Infection control emergency
Rapid reads,is Simon to many people in short space of time
Infection triggers
A complex, variable, and prolonged host response
Sepsis
Is the body’s overwhelming and life threatening response to infection that can lead to tissue damage, organ failure and death
Trigger fro sepsis spectrum
Infection/ trauma
First non specific response in sepsis
Systemic inflammatory response syndrome
SIRS must have what
2 or more of the following
Temperature 38 or more/ 36 or less
HR >90 beats per minute
Respirations 20/min
WBC count > 12000/mm3
Severe sepsis is
Sepsis with more than one sign of organ failure
Sepsis defining criteria
At least 2 SIRS criteria caused by known or suspected to be infectious
Septic shock
Sepsis with persistent or refracrionary hypotension or tissue hypoperfusion despite adequate fluid resusicitation
Microbial components that trigger shock
Endotoxins - gram negative
Lipoteichoic acid- gram positive
Direct - vascular endothelium
Superantigen cause ?
Much faster much more prolonged response to infection
Main causes of infection - related shock and morality
Gram negative - E.coli, other Califorms, meningococcai, pseudomonas,haemophilus
Gram positive,
Staph aureus, group A strep, strep pneumonia, clostridium
Parasites
Fungi
Viruses
Most common conditions associated with septicaemia and shock
Severe UTI with pyelonephritis Meningococcal disease Gut perforation
Infection of intravenous catheters and devices
Skin and soft tissue infection Endocarditis
Pneumonia
Chlolecystitis /Cholangitis / Pancreatitis
Diagnosis of sepsis
Clinical according to sepsis criteria
Specific cause- determine origin
Blood cultures
Other lab tests
Why conditions must be differentiated from sepsis
Sepsis needs antibiotics to treat unlike other conditions
Management of sepsis
Fluids, dopamine, transfusion ICU
Resolution of precipitating problems
Monitor : blood gas , renal function, cns,
Antimicrobials
Outcomes of sepsis
Multi organ failure
Amputations
Prolonged hospital stay
Morality 30-60%
SSC guidelines are
Gold standard of care
How many people does sepsis affect / kill
Affects millions
Kills 1/4
Sepsis 6 is
St of interventions which can be delivered by a junior healthcare professional in a team
What do you need to deliver sepsis 6
Patient with sepsis
Qualified prescriber
Basic healthcare equipment
Steps of sepsis 6
Administer high flow oxygen
Take blood cultures
Give broad spectrum antibiotics
Give intravenous fluid challeneges
Measure serum lactate and haemoglobin
Measure hourly urine output
Sepsis 6 has what benefit
Doing it in first hour you double chance of patient surviving
SSC antimicrobial recommendations
Begin IV antibiotics early (within on hour) of septic shock
Start with broad spectrum antibiotics then declassify
Typical antimicrobial therapies- community acquired infection shock
Origin unknown or …
Gut or renal or binary
Coxamoxiclav + gentamicin
Or (x) + metronidazole + gentamicin
Skin and soft tissue infection treatment
Flucloxacillin + penicillin/amoxicillin+ gentamicin
Pneumonia treatment
Co-amoxiclav + doxycycline
Or
Cefuroxime+ erythromycin
Meningococcal disease treatment
Penicillin or ceftriaxone
Malaria treatment
Quinine
Penicillin or cephalosporin allergy
Rash only
If severe
Rash only- penicillin or cephalosporin depending on allergy
If severe- ciprofloxacin, vancomycin,erythromycin
Hospital acquired infection shock (late)
Gentamicin + piperacillin-tazobactam
Adjunctive measures
Remove infected catheters and devices Drain pus, debride dead tissue Consider lessening immunosuppression therapies Fluid balance etc
Check gentamicin or vancomycin levels
