Sepsis Flashcards
What is sepsis ?
A life threatening organ dysfunction caused by a dysregulated host response to infection. It can lead to septic shock.
Pathophysiology of sepsis
- damage to the host is mainly caused by the uncontrolled release of cytokines in the immune response which leads to widespread vasodilation and capillary leakage.
What is the effect of sepsis on the airways ?
There is generally no specific effect unless infection arises from the throat or neck. However , if patient becomes unconscious then they may be at risk of airway problems.
What is the effect of sepsis on breathing ?
TACHYPNOEA ( raises respiratory rate).
This is because due to the capillaries becoming really leaky , there is more fluid and protein leaking into interstitial tissues leading to lung oedema. So the lungs need to work harder by breathing faster to increase O2 exchange in order to meet the demands of the body.
Another reason for tachypnoea is because of acidemia due to increased lactate production which means that there needs to be an increase in the respiration rate in order to remove all the carbon dioxide in the body.
What is an effect on circulation due to sepsis ?
HYPOVOLAEMIA( lower BP). Due to vasodilation and capillary leakage leading to hypotension.
- this is because capillary leakage and vasodilation decreases systemic vascular resistance - as this decreases , blood pressure will also decrease.
- tachychardia would then arise due to decreased systemic vascular resistance.
- result to organ damage as lack of blood.
What is the effect of sepsis on ‘ disability ‘
Reduced blood flow to the brain . May present as confusion , drowsiness , slurred speech , agitation , anxiety , decreased level of consciousness
What is the effect on temperature from sepsis ?
High temperature due to hypothalamic response to infection.
- however , in the elderly hypothermia could occur ( below 36 degrees)
What is the acronym for the effects of sepsis on organ systems
A irways Breathing Circulation Disability Exposure
What is the overall mortality rate for sepsis?
28.9%
Who is especially at risk of sepsis ?
Very young - less than 1 year old because they cannot express how they feel / what’s hurting them
- elderly ( over 75 year old) or very frail
- pregnant women , post partum ( within last 6 weeks )
- patients with impaired immune system due to illness or drugs ( eg immunosuppressants)
How is sepsis diagnosed ?
Using the National early warning score ( NEWS2)-2017
Use for all non-pregnant adults over 16.
- Acute confused state
- Heart rate above 130bpm
- Responds only to voice or pain / unresponsive
- Systolic BP less than 90mmHg
- Respiratory rate more then 25/min
- needs oxygen to keep Spo2 above 92%.
- Non blanching rash , mottled , ashen , CYANOTIC
- Not passed urine in the last 18hr q
- Lactate above 2mmol/l
- Recent chemotherapy
If a patient has an early warning score of above 3, is visibly unwell , an infection is present or suspected and one of the red flags are true red flag sepsis , how should you act ?
The management of sepsis known as the sepsis 6 care bundle should be used,
- but with NEWS2 if they have a score above 5 - think sepsis.
THE SEPSIS 6 care bundle
1IN ORDER to ensure the most important interventions / tests are prioritised. This can be remembered as the ‘ Three gives and the three takes’
- Give o2 to keep oxygen saturation levels above 94%
- Take blood cultures
- Give IV antibiotics
- Give a fluid challenge
- Measure serum lactate
6, measure urine output
What are some further investigations that may be taken apart from the 3 gives and 3 takes ?
SUPPORTIVE INVESTIGATIONS : - full blood count blood sugar liver function test c reactive protein Coagulation clotting studies Blood gases
SPECIFIC INVESTIGATIONS:
1) CSF
2) throat swab
3( EDTA bottle for PCR
What is the common cause of sepsis ?
Neisseria meningitidis which is a a gram negative bacterium , often found as a diploccocus.
- it is part of normal flora in the nasopharynx of about 10% of population.
