Sepsis Flashcards
Define Sepsis
Sepsis is a life-threatening organ dysfunction due to dysregulated immune response to infection.
Clinically its SIRS + a confirmed infection.
Essentially bacteria invade a sterile comparment e.g. blood or abdominal cavity and release endo/exotoxins leading to uncontrolled inflammatory resposne
Define SIRS?
Systemic Inflammatory Response Syndrome.
A set of symptoms that occur during systemic inflammation e.g. infection, burns, trauma or pancreatitis.
2 or more from:
- High or low Temp
- Tachypnoea or Low PaCO2
- Tachycardia
- Leucocytosis or Leucopenia or >10% band cells (immature WCs)
How do we assess a patient’s organ dysfunction when we suspect Sepsis?
SOFA score (Sepsis Organ Failure Assessment) or qSOFA to identify patients at high risk or death/requiring ICU
Whats included in qSOFA?
High risk is 2 or more of:
- Hypotension <100mmhg
- Altered Mental Status
- Tachypnoea >22breaths/min
Define Septic Shock?
Sepsis (i.e. infection + SIRS) along with refractory hypotension.
I.e. the hypotension requires vasopressors to maintain MAP >65mmHg and serum lactate remains >2mmol/l despite fluids.
Inflammatory mediators released in response to infection can be pro/anti-inflammatory. What happens if there’s an excess of either?
Pro-inflammatory = Septic Shock -> Multi-organ failure and death
Anti-inflammatory = Immunoparalysis -> Uncontrolled infection -> Multi-organ failure and death
How may sepsis present? Think about the different potential organ dysfunctions
Brain - Altered Mental Status
Lungs - Tachypnoea or Low O2
Heart - Tachycardia & Hypotension
Kidneys - Oliguria/anuria and high creatinine
Liver - Jaundice, raised enzymes, INR &bilirubin and low albumin
Systemic - Fever (and associated symptoms e.g. sweat, chills), hypothermia, hyperglycaemia, leucopenia/cytosis, thrombocytopenia, high CRP and +ve D-dimer (clotting)
Along with signs of source infection e.g. wound, peritonitis or pneumonia.
What factors can effect how sepsis presents?
Host - Age, immunosuppression, co-morbidities or surgery
Organism - Virulence factors, bioburden & Gram +ve vs -ve
Environment - Occupation, travel & hospitalisation
What tests can you run for Sepsis?
FBC Glucose U&E + Creatinine LFTs D-dimer & Coagulation study (sepsis causes hypercoagulation) CRP
How do you manage Sepsis?
With the Sepsis 6:
Give 3:
- IV fluid Challenge (30ml/kg/day) (if BP doesnt improve = shock)
- IV Abx (specific to suspected source & cultures)
- O2
Take 3:
- Blood cultures
- Serum Lactate type A (marker of hypoperfusion and poor clinical outcome)
- Urine output monitoring
What tests would you do?
WCC : leucocytopenia( lower WCC)/ leucocytosis (higher WCC)
CRP- HIGH
Procalcitonin- HIGH
U&Es: creatinine increase, oliguria
LFT: hyperbilirubinemia, low albumin, raised enzymes, raised INR
Lactate: increase
02 : decreased capillary perfusion
when would you refer to the HDU?
- Low BP despite fluids
- Lactate> 2
- Elevated creatinine
- Oliguria
- Liver dysfunction
- Hypoxemia
When would you refer to ITU?
- Septic shock
- Multi-organ failure
- Requires sedation, intubation, ventilation
Phases of development
1- release of toxins
2- release of mediators
What are the toxins which can be released
Gram Negatives:
- LPS - lipopolysaccharides
Gram Positives
- superantigens
- microbial associated molecular patterns
