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Infection > Sepsis > Flashcards

Sepsis Flashcards

1
Q

sepsis is characterised by a

A

life-threatening organ dysfunction due to a dysregulated host response to infection and inflammation

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2
Q

septic shock

A

’ persistent hypotension despite fluid resuscitation’

a subset of sepsis where particularly profound circulatory, cellular and metabolic abnormalities substantially increase mortality

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3
Q

why are definitions of sepsis important?

A
  • 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
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4
Q

why is sepsis important?

A
  • 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
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5
Q

what happens in local infection

A

rubor tumor calor dolor

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6
Q

rubor

A

redness

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7
Q

tumor

A

swelling

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8
Q

calor

A

heat

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9
Q

dolor

A

pain

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10
Q

sepsis is

A

systemic inflammation

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11
Q

what happens in sepsis

A
  1. vasodilation 2. capillary leakage 3. amplification
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12
Q

sign of vasodilation

A

warm peripheries

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13
Q

purpose of capillary leakage

A

WBC to site of infection

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14
Q

sign of capillary leakage

A

swelling- may appear oedematous

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15
Q

amplification involves

A

upregulation of cytokines and mediator molecules

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16
Q

the thinking about sepsis’ effect on organ systems

A

think: ABCD

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17
Q

Airway

A

o No specific effect unless infection arises from throat or neck. However, decreased consciousness may be at risk of airway problem

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18
Q

Breathing

A

o Raised respiratory rate (tachypnoea). Fluids and proteins leaking into interstitial tissues lead to lung oedema and decreased lung compliance.

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19
Q

circulation

A

o Hypovolaemia due to vasodilatation and capillary leakage leading to hypotension

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20
Q

hypovolaemia leads to

A

(think of blood pressure = CO x TPR) - tachycardia - end organ damage (ischaemia- hypo perfusion of organs)

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21
Q

why is no urine output a sign?

A

due to hypo-perfusion of the kidney - due to hypovolaemia

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22
Q

disability

A

o Reduced blood flow to brain. May present as confusion, drowsiness, slurred speech, agitation, anxiety or decreased level of consciousness.

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23
Q

Exposure

A

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)

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24
Q

who is at risk of Sepsis

A
  • Very young <1
  • Elderly >75 or very frail
  • Pregnant, post partum (within last 6 weeks
  • Immunocompromised
  • asplenic
  • wound or injury
  • invasive devices
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25
Q

think sepsis if….

A

patient is: - Is triggering an early warning score - Looks ill (to a health professional or an unusually concerned relative) - Has any sign of infection

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26
Q

what is used to give an early warning score

A

National early warning score (NEWS2)

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27
Q

National early warning score (NEWS2) used to

A
  • Used to identify and respond to patients at risk of clinical deterioration
28
Q

NEWS2 is validated for

A

use in non-pregnant adults (age 16 and over)

29
Q

which physiological measurements are taken into consideration by NEWS2 (6)

A

o respiration rate o oxygen saturation o systolic blood pressure o pulse rate o level of consciousness or new confusion* o temperature

30
Q

an elevated NEWS2 score

A

does not provide diagnosis- helps identify patients who need urgent clinical review - Clinical judgement important. Some patients may score high but constant review not appropriate e.g. end of life.

31
Q

a NEWS2 score of >……… THINK SEPSIS

A

5

32
Q

what is a more specific screen for sepsis than NEWS2

A

Red flag sepsis

33
Q

Red flag sepsis

A
  • Not a formal diagnosis but a criteria using measurements already done or easily obtainable bedside test to identify patients with a high likelihood of a degree of organ dysfunction - Patients are at high risk of deterioration
34
Q

how to use red flag sepsis

A

is any one red flag present?

35
Q

name the 9 red flags

A
  • AVPU= VP or U (if changed from normal) - acute confusion - respiratory rate >25 - Needs O2 to keep spO2 above 92% (88% if COPD) - heart rate >130 bpm -systolic bp <90 mmHg - not passed urine in last 18h - non blanching rash, mottled/ ashen/cyanotic - recent chemotherapy (last six weeks)
36
Q

AVPU

A

consciousness “alert, verbal, pain, unresponsive”

37
Q

how is sepsis managed

A

sepsis 6

38
Q

give the sepsis 6

A

3 in - give oxygen - give IV antibiotics - consider fluids 3 out - monitor urine output - take cultures - take HB and lactate

39
Q

how to take a blood culture

A
  1. 5ml of blood taken into anaerobic and aerobic bottles 2. Put bottles into machine which sit on incubator for 5 days 3. If you have high levels of carbon dioxide (produced by bacteria) the blood culture precipitate at the bottom of the bottle will change colour and automatically feedback to the machine 4. Blood that tests positive has a gram stain 5. Also grown on agar plate with paper discs soaked in antibiotics to see if pathogen is resistant or susceptible to antibiotics
40
Q

tumbler test

A
  • If you add glass and it disappears- blanching - If the area stays red- non blanching
41
Q

blanching=

A

sign of sepsis

42
Q

supportive investigations

A
  • Full blood count - Urea and Electrolytes - Blood sugar - Liver Function Tests - C-Reactive protein (CRP) - Coagulation (clotting) studies - Blood gases
43
Q

specific investigations

A
  • Cerebrospinal Fluid - Throat swab - EDTA bottle for PCR
44
Q

cerebrospinal fluid

A
  • Lumbar puncture - Urgent transport of CSF to lab - Glucose and protein estimation in biochemistry, microscopy and culture in microbiology
45
Q

normal CSF

A

clear and colourless

46
Q

CSF with infection

A

cloud or turbid- bacteria or WBC

47
Q

meningococcus is caused by

A

Neisseria meningitis

48
Q

Neisseria meningitis

A

gram negative diplococcus - 25% of young adults may be carriers -

49
Q

Neisseria meningitis spread by

A

aerosols and nasopharyngeal secretions

50
Q

endotoxin of Neisseria meningitis

A

LPS

51
Q

treatment of meningitis

A

ceftriaxone

52
Q

ceftriaxone is the first line

A

because needs to be able to cross the BBBq

53
Q

prevention of meningitis

A

vaccination Men B, Men C, Men ACWY

54
Q

prophylaxis for meningitis

A

for close contacts

55
Q

Meningitis is a………..disease and N.meningitidis is a ………. organism

A

notifiable

56
Q
A
57
Q

complication of sepsis (due to cytokines)

A

DIC where multiple clots form within the vessels using up clotting factors. Cytokines trigger thrombin production, thereby promoting coagulation and also inhibiting fibrinolysis -> the coagulation cascade leads to microvascular thrombosis -> ultimately progressing to organ ischaemia, dysfunction and failure.

58
Q
A
59
Q

most likely causative organism varies by

A

age of the patient

60
Q

classic symptoms of meningococcal meningitis

A

non-blanching purpuric rash (tested using the glass or tumbler test), a stiff neck, confusion, dislike of bright lights (photophobia), drowsiness, aching muscles and joints.

61
Q

sign of meningitis in neonates

A

fontanelle (hole in the skull when born) might feel soft and bulging

62
Q

what type of antibiotic is cephalosporin

A

ceftriaxone

63
Q

antibotics given for sepsis with no signs of emningitis

A

meropenem (a carbopenom)

64
Q

antibiotics when a severe gam negative sepsis is suspected

A

gentamicin

65
Q

which fungus most liekly to cause sepsis

A

candida

66
Q

Patient symptoms

A
  • Severe muscle pain
  • Less urine output (no perfusion to kidneys)
  • Nausea
  • Vomiting
  • Diarrhoea
  • Feeling faint
  • Change in mental state
  • Breathlessness
67
Q
A

Infection (36 decks)

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