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Infection > Sepsis > Flashcards

Sepsis Flashcards

1
Q

Definition of sepsis

A

-life-threatening organ dysfunction caused by dysregulated host response to infection

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2
Q

Definition of septic shock

A

-can be identified with a clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP >65mmHg and having a serum lactate of >2mmol/l despite adequate volume resuscitation

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3
Q

qSOFA

A 
Prognostic indicator
-hypotension systolic BP <100mmHg
-altered mental status
-tachypnoea RR >22/min
Score of 2 or more criteria suggests a greater risk of poor outcome
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4
Q

Pathophysiology of sepsis

A
  • Uncontrolled inflammatory response
  • Patients with sepsis have features consistent with immunosuppression:
    - Loss of delayed hypersensitivity
    - Inability to clear infection
    - Predisposition to nosocomial infection
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5
Q

Three phases in the pathogenesis of sepsis

A

Three phases in the pathogenesis of sepsis
1 -release of bacterial toxins
2 -release of mediators
3 -effects of specific excessive mediators

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6
Q

Release of bacterial toxins

A
  • Bacterial invasion into body tissues is a source of dangerous toxins
  • May or may not be neutralised and cleared by existing immune system
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7
Q

Mediator role in sepsis (Th1 vs Th2)

A
  • Two types of mediators can be released
  • Pro-inflammatory mediators – causes inflammatory response that characterises sepsis
  • Compensatory anti-inflammatory reaction – can cause immunoparalysis
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8
Q

Effects of excessive pro-inflammatory mediators

A
  • Promote endothelial cell – leukocyte adhesion
  • Release of arachidonic acid metabolites
  • Complement activation
  • Vasodilatation of blood vessels by NO
  • Increase coagulation by release of tissue factors and membrane coagulants
  • Cause hyperthermia
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9
Q

Effects of excessive anti-inflammatory mediators

A
  • Inhibit TNF alpha
  • Augment acute phase reaction
  • Inhibit activation of coagulation system
  • Provide negative feedback mechanisms to pro-inflammatory mediators
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10
Q

General feature of Sepsis

A
  • Fever >38oC – presenting as chills, rigors, flushes, cold sweats, night sweats, etc
  • Hypothermia <36oC – especially in the elderly and very young children (remember the immunosuppressed)
  • Tachycardia >90 beats/min
  • Tachypnoea >20 /min
  • Altered mental status – especially in the elderly
  • Hyperglycaemia >8mmol/l in the absence of diabetes
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11
Q

Nervous system features of sepsis

A
  • Altered consciousness
  • Confusion
  • Psychosis
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12
Q

Respiratory system features of sepsis

A
  • Tachypnoea
  • PaO2: <70mmHg
  • Sats: <90%
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13
Q

Hepatic features of sepsis

A
  • Jaundice
  • ↑ Liver enzyment
  • ↓ Albumin
  • ↑ PT
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14
Q

Cardiac features of sepsis

A
  • Arterial hypotension (systolic <90mmHg or MAP <70mmHg)
  • tachycardia
  • SvO2 >70%
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15
Q

Blood features of sepsis

A

↓ Platelets
↓ Protein C
↑ PT/APTT
↑ D-dimer

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16
Q

Renal features of sepsis

A
  • Oliguria (<0.5ml/kg/h)
  • Anuria
  • ↑ Creatinine
17
Q

Inflammatory variables in sepsis

A
  • Leucocytosis (WCC > 12,000/ml)
  • Leucopenia (WCC < 4,000/ml)
  • Normal WCC with greater than 10% immature forms
  • High CRP
  • High procalcitonin
18
Q

Tissue perfusion variables in sepsis

A
  • High lactate

- Skin mottling and reduced capillary perfusion

19
Q

Sepsis 6

A

Take 3: Give 3

  • Blood cultures
  • Blood lactate
  • Measure urine output
  • Oxygen aim sats 94-98%
  • IV Antibiotics
  • IV fluid challenge (30ml/kg)
20
Q

When to consider HDU referral for sepsis

A
  • Low BP responsive to fluids
  • Lactate >2 despite fluid resuscitation
  • Elevated creatinine
  • Oliguria
  • Liver dysfunction, Bil, PT, Plt
  • Bilateral infiltrates, hypoxaemia
21
Q

When to consider ITU referral for sepsis

A
  • Septic shock
  • Multi-organ failure
  • Requires sedation, intubation and ventilation

Infection (15 decks)

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