Sepsis Flashcards
What is colonisation
Presence of a microbe in the body without an inflammatory response
What is infection
Inflammation due to a microbe
What is bacteraemia
Presence of viable bacteria in the blood
What is the definition of sepsis
The dysregulated host response to infection leading to life-threatening organ dysfunction
What is septic shock
Subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality
These patients will not get better despite adequate volume resuscitation
What is the general indicator for sepsis
NEWS > 5 with a suspicion of infection
What is SIRS
Systemic inflammatory response syndrome
Higher the NEWS, the higher the mortality - true or false
TRUE
What is qSOFA
A quick scoring system for sepsis
3 criteria
List evidence of infection
Fever Abnormal bloods Cough Abdominal pain Confusion
ARDS can be a consequence of sepsis - true or false
True
What is the immediate management for sepsis
Sepsis 6
Take 3 - blood cultures, lactate and urine output
Give 3 - oxygen, IV fluids and IV antibiotics
Describe how fluids are given in the sepsis 6 bundle
Give a fluid challenge (set volume over a set time)
Prescribe 250-500mls over 15 mins (saline or Hartmanns)
Aim for MAP >65mmHg
Aim for 30ml/kg over the first 3 hours
Do you just do blood cultures in the sepsis 6
Not necessarily
Can also do sputum, urine or stool depending on the suspected
What is high lactate a sign of
Hypoperfusion
Associated with a higher mortality
What is urine output a marker for
Organ perfusion
What urine output should you aim for
0.5mls per kilo per hour
In hours 2-6 after sepsis diagnosis, what are you aiming for
Improvement in NEWS, haemodynamic stability and reduction in lactate
Continue resuscitation in this time
If the sepsis 6 bundle does not improve the condition what is happening
The patient is in septic shock
Need to escalate treatment and send to MHDU
If MAP remains below 65 after fluid resuscitation what do you do
Give noradrenalin (vasopressor) via central line
Why is sepsis increasing
Better at recognising it Increased elderly population Increased use of invasive surgery Bacterial resistance Increased numbers of immunocompromised patients
What are risk factors for sepsis
Extremes of age Immunocompromised Malignancy Trauma Burns Co-morbidities such as diabetes Alcohol and drug abuse
List some late complications of sepsis
Functional limitations 3x higher rate of cognitive impairment Mental health 40% readmitted within 90 days Higher risk of recurrent infection, kidney impairment and CV disease Residual organ damage Impaired immune function
What is post-sepsis syndrome
Causes a variety of emotional and physical problems
E.g. myalgia, insomnia, sensory change, mood swings
Lasts 6-18 months
List common symptoms of sepsis
High or low temperature Uncontrolled shivering Low urine output Blotchy rash Confusion
What is virulence
Likelihood of a pathogen causing disease
In which situation is staph epidermidis likely to cause disease
If there is prosthetic material such as plastic or metal
What is a strict aerobe
Organisms that require oxygen for growth, such as Pseudomonas
How does sepsis affect the CV system
Hypotension due to widespread vasodilatation leading to fall in total peripheral resistance
How do you correct hypotension in sepsis
fluid resuscitation +/- inotropes / vasoconstrictors
How does sepsis affect the respiratory system
Endothelial injury within lung tissue / capillary leak
Diffuse alveolar oedema
Respiratory failure, needing supplemental oxygen
How does sepsis affect the kidneys
Acute kidney injury - rise in Urea/Creatinine or oligo-anuria due to renal hypoperfusion
How does sepsis affect the liver
Gives you ‘shock liver’
Elevated ALT/AST +/- jaundice
How does sepsis affect the CNS
Delirium / acute confusional state due to diffuse cerebral hypoperfusion / dysfunction
May become drowsy / decreased conscious level
How does sepsis lead to lactic acidosis
Diffuse tissue hypoperfusion / hypoxia
Anaerobic metabolism leads to lactic acid production -> metabolic acidosis
Acidosis worsens cardiovascular stability
What blood markers are raised in sepsis
IL-6, CRP and white cell count
What blood markers are lowered in sepsis
Platelets
