Sepsis Flashcards
TBL
Define Sepsis
The presence (probable or documented) of infection together with systemic manifestations of infection
What are the signs of sepsis?
Pyrexia - >39 degrees
Pallor - red/patchy/white. sleepy/tired
Tachycardia - 120 bpm
Raised infection markers in blood (CRP, WCC)
Need raised infection markers PLUS one more
Define severe sepsis
Sepsis PLUS sepsis-induced organ dysfunction or tissue hypoperfusion
What are the signs of severe sepsis?
Low urine output - <0.5ml/kg/hr Low arterial oxygen concentrations Changes in blood clotting - INR >1.5 Raised bilirubin - >70 micromol/L Raised lactate - >1mmol/L
Define septic shock
Sepsis induced hypotension persisting despite fluid resuscitation
What are the signs of septic shock?
Systolic BP <90mmHg
OR MAP 70mmHg
What is the pathology of sepsis?
Release of inflammatory cytokines (TNF, IL-1, IL-6)
Nitric oxide release
Activation of complement (cell recruitment)
Endothelial activation (porous- proteins out to find source of infection)
Vasodilation causes a reduction in systemic vascular resistance
Body becomes relatively fluid deplete
Perfusion of tissues is reduced
What is the sepsis six?
Administer oxygen Give broad spec antibiotics Take blood cultures Give fluid resuscitation Measure lactate and haemoglobin Measure urine output
What indicates oxygen levels?
Lactate
Venous oxygen saturation - probe on finger
What indicates the fluid resuscitation is working?
Lactate
Venous oxygen saturation
Urine output
Blood pressure
What is a good urine output?
> 0.5ml/kg/hr
Sources of infection
Respiratory Abdominal - peritonitis/appendicitis UTI Soft tissue, Bone Joint Other Indwelling
Risk factors for sepsis
Immunocompromised Neonates and infants (2 or 3 before full immune system) Chronic disease Recent surgery Invasive procedures
What is the UK mortality for septic shock?
Around 50%
What does hypovolaemia mean?
Fluid deplete
