Sepsis Flashcards
What things can cause a SIRS response?
Infection
Burns
Trauma
Surgery
What does SIRS consist of?
Temperature <36, >38
RR >20
HR >90
WCC <4, >12
Define sepsis:
A potentially life threatening organ dysfunction due to dysregulated immune response to infection.
clinically there has to be:
- evidence of infection
+
- a systemic response such as SIRS/ qSOFA
What is severe sepsis?
Sepsis + Organ dysfunction or tissue hypoperfusion
- AKI
- thrombocytopenia
- Hyperlactatemia
What is septic shock?
Sepsis + persistent hypoperfusion despite adequate fluid resuscitation - MAP: <65mmHg or - >40mmHg drop in systolic \+ Lactate increase
What are some risk factors for sepsis?
Immunocompromised
- extremes of age
- AIDS
- Medication
- Malnutrition
- pregnancy
Indwelling devices:
- Peripheral venous catheters
- Central venous catheters
- Arterial line
- Urethral catheter
- Drains
Trauma:
- recent surgery
Outline pathophysiology of sepsis:
Pro-inflammatory cytokines released affecting endothelium functioning
Blood vessels become leaky
Induced hypovolaemia
this reduces Cardiac output
eventually the build up of hypoxemia and acidosis directly affect the heart and its ability to pump
DIC may occur
- inducing thrombosis and bleeding causing multiorgan failure.
What clinical signs may you see in septic shock?
lowered GCS
Hypoxia
Tachypnoea
Warm flushed peripheries
in later stages the extremities will go cold
What generalised investigations do you want to do into sepsis?
Bloods:
- FBC - WWC, Platelets
- U&Es - is kidney coping
- LFTs - source & complication of sepsis
- CRP
- Coagulation studies - DIC?
- ABG/ VBG - lactate and acidosis?
- blood cultures
Orifices:
- Dip stick - leukocytes and nitrites
- Throat swap
- Sputum cultures - for source
- Stool cultures - for source
X-ray
- CXR as source
- Signs of ARDS
ECG
- to monitor how the heart is functioning
Special tests:
- Echo - if murmur
- Lumbar puncture - if evidence of meningitis
- CT if still not clear
How is Sepsis managed?
ABCDE approach
- making sure you get stats on patient
Sepsis 6
- started within 1 hour
Remove any suspected sources
- catheter
- IV lines
Early goal directed therapy
- septic shock patients should ideally have a central line inserted for monitoring and fluid boluses
If the source of the infection is unknown what antibiotics should be prescribed?
Broad spectrum should be prescribed - Amoxicillin \+ - Gentamicin \+/- - Flucloxacillin (if skin involvement) \+/- - Clindamycin (if severe strep infection)
MRSA or allergic:
- Vancomycin
+
- Gentamicin
What are some complications to sepsis?
Respiratory failure
- Acute lung injury
- ARDS
Cardiac failure
Renal failure
Septic shock
DIC
Death
What is sepsis 6?
Take:
- blood cultures
- Measure urine output
- Measure lactate
Give:
- High flow oxygen
- IV antibiotics
- IV fluids
What is q SOFA made up of?
reduced GCS
RR >22
BP <100
What does the entire SOFA consist of?
paO2 Hypotensive Reduction in platelets Reduced GCS Increased bilirubin Creatinine increase
