Sepsis Flashcards
What is sepsis?
Is a life-threatening condition.
When the body’s infection causes injury to its own tissue and organs.
What is the definition of Organ Dysfunction in sepsis?
An acute change in total qSOFA score by more than 2 points after infection
What is qSOFA?
A screening tool to assess prognosis of SEPSIS. It looks for:
Hypotension
Altered Mental Status
Tachypnoea
What is a bad qSOFA score?
A score higher than 2 reflects 10% mortality in a general hospital population.
What factors from the HOST may effect presentation of Sepsis? (4)
1) Age
2) Comorbidities (COPD / DM)
3) Immunosupression
4) Previous Surgery
What things can cause a patient to be immunosuppressed? (3)
- Acquired (HIV)
- Drug Induced
- Congenital
What about the ORGANISM may effect presentation of Sepsis? (3)
1) Gram +ve / Gram -ve?
2) Virulence factors (for MRSA)
3) Bioburden
What environments make a person susceptible to sepsis? (3)
1) Hospitalisation
2) Occupation
3) Travel
How can sepsis present? (7)
- Fever
- Altered Mental Status
- Tachycardia
- Tachypnoea
- Hypothermia
- Hypotension
- Hyperglycaemia
What are some symptoms which suggest that a patient has a fever? (6)
- Temperature >38°C
- Chills
- Rigors
- Flushes
- Cold sweats
- Night sweats
What are some symptoms which suggest that a patient has hypothermia? (4)
- Temperature < 36°C
- Elderly
- Very young children
(hypothermia is more likely to present in immunosupressed patients)
What is defined as hyperglycaemia?
When blood sugar levels above 8mmol/l
in the absence of diabetes.
What inflammatory markers / variables do we look for in patients suspected of sepsis? (5)
- Normal WCC (with >10% immature forms)
- Leucocytosis
- Leucopenia
- High CRP
- High procalcitonin
What is a high procalcitonin an indicator for?
It’s a sign of Active Infection
What is the biochem definition of leucocytosis?
WCC > 12,000/ml
What is the biochem definition of leucopenia?
WCC < 4,000/ml
What variables suggest organ dysfunction in sepsis? (7)
- Arterial hypoxaemia
- Coagulation Abnormalities
- Thrombocytopenia
- Hyperbilirubinaemia
- Creatinine Increase
- Ileus
- Oliguria
What are some haemodynamic variables in sepsis? (2)
1) Arterial hypotension
- systolic <90mmHg or
- MAP <70mmHg)
2) SvO2 >70% (venous oxygen)
What are some tissue perfusion signs that are apparent in in sepsis? (2)
- High lactate
- Skin mottling & reduced capillary perfusion
What is Sepsis6?
The treatment plan for SEPSIS.
Take 3, give 3.
What are the “take 3” in sepsis6?
Take:
1) Blood cultures (microbiology)
2) Blood lactate (hypoperfusion/severe sepsis)
3) Urine output (renal)
What are the “give 3” in sepsis6?
Give:
1) Oxygen
2) I.V. Antibiotics
3) I.V. Fluid Challenge
When do we consider a HDU referral of a sepsis patient? (7)
- Low BP
- Response to fluids
- Lactate > 2 (despite fluid resuscitation)
- Elevated creatinine
- oliguria
- liver dysfunction
- hypoxaemia
- bilateral inflitrates
When do we consider an ITU referral of a sepsis patient? (4)
- Septic shock
- Requires intubation and ventilation
- Multi-organ failure
- Requires sedation
What is the progression path of sepsis?
SIRS --> Sepsis --> Severe Sepsis --> Septic Shock
What is Septic Shock?
Dangerously low BP and cellular abnormalities due to sepsis.
Why do patients in septic shock need vasopressors to maintain a MAP of >65mmHg?
Persisting hypotension
What is the hospital mortality rate of septic shock?
40%
for every hour delay in administering Abx this increases by 7.6%
How do we treat septic shock?
- Take bloods for culture
- Immediately start Abx therapy
- Pray to god.
