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BS - Renal System > Sepsis > Flashcards

Sepsis Flashcards

1
Q

What is sepsis?

A

Sepsis is caused by the way the body responds to an infection

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2
Q

What are the 4 things that sepsis can lead to?

A
  1. increased capillary permeability
  2. multiple organ failure
  3. cardiovascular collapse
  4. death
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3
Q

What does increased capillary permeability lead to?

A

Vasodilatation and hypotension lead to shock

This results in underperfusion to multiple organs, which leads to organ failure

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4
Q

What is the definition of sepsis?

A

Life-threatening organ dysfunction caused by a dysregulated host response to infection

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5
Q

How can organ dysfunction can be represented?

A

It is represented by an increase in the SOFA score >/= 2

Sequential Organ Failure Assessment

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6
Q

What does a SOFA score >/= 2 suggest?

A

An in-hospital mortality greater than 10%

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7
Q

What is septic shock characterised by?

A

Profound circulatory, cellular and metabolic abnormalities

It has a greater risk of mortality than with sepsis alone

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8
Q

What is the vasopressor requirement in septic shock?

A

The vasopressor requirement to maintain a mean arterial pressure >/= 65 mmHg

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9
Q

In the absence of hypovolemia, what is serum lactate level in septic shock?

A

Serum lactate level > 2 mmol/L

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10
Q

What is the hospital mortality rate in patients with septic shock?

A

Hospital mortality rates > 40%

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11
Q

What is qSOFA?

A

quick SOFA

It is a bedside clinical score that is used in adult patients

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12
Q

What does qSOFA say about patients with suspected infection?

A

They are more likely to have poor outcomes if they have a qSOFA of at least 2 of:

  1. respiratory rate >/= 22/min
  2. altered mentation
  3. systolic blood pressure = 100 mmHg
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13
Q

What “multiple organ failures” can result from sepsis?

A
  1. acute lung injury
  2. cardiovascular instability (hypotension)
  3. acute kidney injury
  4. gastrointestinal mucosal injury
  5. liver dysfunction
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14
Q

How can a GI mucosal injury worsen sepsis?

A

bacteria in the gut translocate into the bloodstream

this worsens sepsis

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15
Q

Which healthy people are most vulnerable to sepsis?

A
  1. people < 1 year
  2. people > 75 years
  3. very frail people
  4. intravenous drug users
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16
Q

What types of treatments make people more vulnerable to sepsis?

A
  1. recent trauma or surgery in that last 6 weeks
  2. impaired immunity due to illness or drugs (steroids, chemotherapy, immunosuppressants)
  3. indwelling lines/catheters
  4. any breach of skin integrity - cuts, burns, blisters, skin infections
17
Q

When considering whether a patient has sepsis, what 2 factors should be taken into consideration?

A
  1. people with sepsis may have non-specific, non-localising presentations
    (e. g. generally feeling unwell)
  2. pay attention to concerns expressed by the person or family member
18
Q

What are the high risk criteria for sepsis?

A
  1. objective evidence of new altered mental state
  2. respiratory rate >/= 25 breaths/min
  3. new need for oxygen
  4. heart rate >/= 130 bpm
19
Q

What is the aim for oxygen saturation in patients?

A

more than 92% in healthy people

more than 88% in people with COPD

20
Q

What are the high risk criteria relating to blood pressure?

A
  1. systolic blood pressure = 90 mmHg

OR

systolic blood pressure > 40 mmHg below what is normal for that patient

21
Q

What are the high risk criteria relating to urine?

A

No urine being passed in the previous 18 hours

OR

passing less than 0.5 ml/kg urine per hour for catheterised patients

22
Q

What are the high risk criteria relating to appearance?

A
  1. mottled or ashen appearance
  2. cyanosis of skin, lips or tongue
  3. non-blanching rash of skin
23
Q

In the response to suspected sepsis, what venous blood tests should be performed?

A
  1. blood gas including lactate and glucose
  2. blood culture
  3. full blood count
  4. C-reactive protein
  5. urea and electrolytes
  6. creatinine
  7. clotting screen
24
Q

What other cultures should be collected in response to suspected sepsis?

A
  1. sputum
  2. urine
  3. wound swab
25
Q

What treatment should be given as a first response to suspected sepsis?

A
  1. intravenous fluids

2. intravenous antibiotics within one hour of identification of high risk criteria

26
Q

What is the BUFALO acronym for the sepsis6?

A

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

27
Q

When should BUFALO be carried out?

A

All the actions should be completed within an hour of a suspected sepsis case

28
Q

Why are intravenous fluids prescribed?

A

To correct hypovolaemia

29
Q

What are the 2 types of hypovolaemia?

A
  1. true hypovolaemia

2. relative hypovolaemia

30
Q

What is true hypovolaemia?

A

When the rate of fluid loss of extracellular fluid exceeds net intake

e.g. vomiting, diarrhoea, haemorrhage

31
Q

What is relative hypovolemia?

A

When there is a decrease in the effective circulating volume

e.g. sepsis - vasodilation

32
Q

How is hypovolaemia corrected?

What is the outcome of this?

A

Restoring the circulating volume by rapidly expanding the intravascular space

This restores blood pressure and organ perfusion

33
Q

What resuscitation fluids are used?

A

Crystalloids

This involves 500ml Hartman’s solution

AND

500 ml 0.9% sodium chloride

These are given over a time period of 15 minutes

34
Q

When do you decide which antibiotics to prescribe to a septic patient?

A

After looking at the cultures

This ensures that the antibiotics are effective - antimicrobial resistance

BS - Renal System (8 decks)

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