Sepsis Flashcards
What is sepsis?
Sepsis is caused by the way the body responds to an infection
What are the 4 things that sepsis can lead to?
- increased capillary permeability
- multiple organ failure
- cardiovascular collapse
- death
What does increased capillary permeability lead to?
Vasodilatation and hypotension lead to shock
This results in underperfusion to multiple organs, which leads to organ failure
What is the definition of sepsis?
Life-threatening organ dysfunction caused by a dysregulated host response to infection
How can organ dysfunction can be represented?
It is represented by an increase in the SOFA score >/= 2
Sequential Organ Failure Assessment
What does a SOFA score >/= 2 suggest?
An in-hospital mortality greater than 10%
What is septic shock characterised by?
Profound circulatory, cellular and metabolic abnormalities
It has a greater risk of mortality than with sepsis alone
What is the vasopressor requirement in septic shock?
The vasopressor requirement to maintain a mean arterial pressure >/= 65 mmHg
In the absence of hypovolemia, what is serum lactate level in septic shock?
Serum lactate level > 2 mmol/L
What is the hospital mortality rate in patients with septic shock?
Hospital mortality rates > 40%
What is qSOFA?
quick SOFA
It is a bedside clinical score that is used in adult patients
What does qSOFA say about patients with suspected infection?
They are more likely to have poor outcomes if they have a qSOFA of at least 2 of:
- respiratory rate >/= 22/min
- altered mentation
- systolic blood pressure = 100 mmHg
What “multiple organ failures” can result from sepsis?
- acute lung injury
- cardiovascular instability (hypotension)
- acute kidney injury
- gastrointestinal mucosal injury
- liver dysfunction
How can a GI mucosal injury worsen sepsis?
bacteria in the gut translocate into the bloodstream
this worsens sepsis
Which healthy people are most vulnerable to sepsis?
- people < 1 year
- people > 75 years
- very frail people
- intravenous drug users
What types of treatments make people more vulnerable to sepsis?
- recent trauma or surgery in that last 6 weeks
- impaired immunity due to illness or drugs (steroids, chemotherapy, immunosuppressants)
- indwelling lines/catheters
- any breach of skin integrity - cuts, burns, blisters, skin infections
When considering whether a patient has sepsis, what 2 factors should be taken into consideration?
- people with sepsis may have non-specific, non-localising presentations
(e. g. generally feeling unwell) - pay attention to concerns expressed by the person or family member
What are the high risk criteria for sepsis?
- objective evidence of new altered mental state
- respiratory rate >/= 25 breaths/min
- new need for oxygen
- heart rate >/= 130 bpm
What is the aim for oxygen saturation in patients?
more than 92% in healthy people
more than 88% in people with COPD
What are the high risk criteria relating to blood pressure?
- systolic blood pressure = 90 mmHg
OR
systolic blood pressure > 40 mmHg below what is normal for that patient
What are the high risk criteria relating to urine?
No urine being passed in the previous 18 hours
OR
passing less than 0.5 ml/kg urine per hour for catheterised patients
What are the high risk criteria relating to appearance?
- mottled or ashen appearance
- cyanosis of skin, lips or tongue
- non-blanching rash of skin
In the response to suspected sepsis, what venous blood tests should be performed?
- blood gas including lactate and glucose
- blood culture
- full blood count
- C-reactive protein
- urea and electrolytes
- creatinine
- clotting screen
What other cultures should be collected in response to suspected sepsis?
- sputum
- urine
- wound swab
What treatment should be given as a first response to suspected sepsis?
- intravenous fluids
2. intravenous antibiotics within one hour of identification of high risk criteria
What is the BUFALO acronym for the sepsis6?
B - blood cultures and septic screen
U - urine output, monitor hourly
(also U and Es)
F - fluid resuscitation
A - antibiotics IV
L - lactate measurement from arterial or venous blood gas
O - oxygen to correct hypoxia
When should BUFALO be carried out?
All the actions should be completed within an hour of a suspected sepsis case
Why are intravenous fluids prescribed?
To correct hypovolaemia
What are the 2 types of hypovolaemia?
- true hypovolaemia
2. relative hypovolaemia
What is true hypovolaemia?
When the rate of fluid loss of extracellular fluid exceeds net intake
e.g. vomiting, diarrhoea, haemorrhage
What is relative hypovolemia?
When there is a decrease in the effective circulating volume
e.g. sepsis - vasodilation
How is hypovolaemia corrected?
What is the outcome of this?
Restoring the circulating volume by rapidly expanding the intravascular space
This restores blood pressure and organ perfusion
What resuscitation fluids are used?
Crystalloids
This involves 500ml Hartman’s solution
AND
500 ml 0.9% sodium chloride
These are given over a time period of 15 minutes
When do you decide which antibiotics to prescribe to a septic patient?
After looking at the cultures
This ensures that the antibiotics are effective - antimicrobial resistance
