Sepsis Flashcards
sepsis is characterised by a
life-threatening organ dysfunction due to a dysregulated host response to infection and inflammation
septic shock
’ persistent hypotension despite fluid resuscitation’
a subset of sepsis where particularly profound circulatory, cellular and metabolic abnormalities substantially increase mortality
why are definitions of sepsis important?
- Use of a common language to improve communication between health professions and between healthcare and its patients - Use of language suitable to educate the public about the condition - The establishment of criteria and thresholds beyond which intervention is recommended - Provision of a criteria to determine eligibility for inclusion in a clinical trial
why is sepsis important?
- 5% of emergency department admissions - overall mortality rate of 28.9% - 250,000 cases a year in the UK - rising incidence of 11.5% a year
what happens in local infection
rubor tumor calor dolor
rubor
redness
tumor
swelling
calor
heat
dolor
pain
sepsis is
systemic inflammation
what happens in sepsis
- vasodilation 2. capillary leakage 3. amplification
sign of vasodilation
warm peripheries
purpose of capillary leakage
WBC to site of infection
sign of capillary leakage
swelling- may appear oedematous
amplification involves
upregulation of cytokines and mediator molecules
the thinking about sepsis’ effect on organ systems
think: ABCD
Airway
o No specific effect unless infection arises from throat or neck. However, decreased consciousness may be at risk of airway problem
Breathing
o Raised respiratory rate (tachypnoea). Fluids and proteins leaking into interstitial tissues lead to lung oedema and decreased lung compliance.
circulation
o Hypovolaemia due to vasodilatation and capillary leakage leading to hypotension
hypovolaemia leads to
(think of blood pressure = CO x TPR) - tachycardia - end organ damage (ischaemia- hypo perfusion of organs)
why is no urine output a sign?
due to hypo-perfusion of the kidney - due to hypovolaemia
disability
o Reduced blood flow to brain. May present as confusion, drowsiness, slurred speech, agitation, anxiety or decreased level of consciousness.
Exposure
o High temperature due to hypothalamic response to infection. o Beware hypothermia ( < 36°C) especially in elderly (don’t have same response as young- so sick cant mount temp response)
who is at risk of Sepsis
- Very young <1
- Elderly >75 or very frail
- Pregnant, post partum (within last 6 weeks
- Immunocompromised
- asplenic
- wound or injury
- invasive devices
