Sepsis Flashcards
what is infection?
invasion and multiplication of micro-organisms within the body:
bacterial, fungi, viruses, parasites
may be localised i.e. abscess
may be disseminated i.e. bacteraemia
some organisms live locally in the areas and are not considered infection
what is sepsis?
evidence of infection plus evidence of organ dysfunction
a serious complication of infection with an associated mortality
can rapidly progress to multi-organ failure and septic shock due to the overwhelming host response
requires a high index of suspicion, early identification and rapid treatment - picked up by news chart
how to identify sepsis?
NEWS >5
evidence of infection: cough, dysuria, abdominal pain, abnormal bloods
what is the disease progression of sepsis?
infected - evidence of infection
sepsis - evidence of organ dysfunction plus infection
septic shock - hypotension despite fluid resuscitation (30ml/kg) abd vasopressors
lactate >2
what is sepsis 6?
blood cultures - take 3 lactate measure urine output oxygen -give 3 IV fluids IV antibiotics
oxygen
target saturation , so measure
titrate oxygen level to 94%-98%
if concerned measure ABC, useful information on both oxygenation and metabolic dysfunction quickly
blood cultures
all cultures
take blood cultures but also sputum or urine if thought to be the source
also, consider other sources of sepsis here? abscess? skin.soft tissue? collection
consider source control
IV antibiotics
administered as soon as possible and preferably within the saturation,
an attempt should be made to localise the infection and prescribe appropriately
IV fluids
fluid challenge = set volume over set time
prescribe 250-500mls over 15 mins (crystalloid - 0.9% saline or Hartmann’s)
aim for MAP >65mmHg
Aim for 30ml/kg over the first 3 hours
if lack of response in BP then consider early transfer to MHDU for CVC plus/minus vasopressors
dextrose vs crystalloid
crystalloid stays in the Intravascular space
Dextrose - varies a lot
lactate
measure lactate (and other bloods)
High lactate, sign of hypoperfusion (low BP) in sepsis
High lactate associated with high mortality
if>4 then this should be repeated at 4-6 hours
measure urine output
marker of organ perfusion
fluid balance should be commenced on admission
may require catheter insertion
0.5mls per Kg/hour - aim for
hours 2-6
continue resuscitation:
aim for 30ml/kg in first 3 hours
MAP >65
urine output >0.5ml/kg/hour
what are we aiming for in hours 2-6?
improvement in NEWS
haemodynamic instability
reduced lactate
The deteriorating patient
deteriorating NEWS
NEWS score that is not responding to treatment
concerning signs:
-new confusion
High RR - surrogate for metabolic acidosis
Low BP
Low BM
