Sepsis Flashcards
What is sepsis?
Caused by the way the body responds to infection Life-threatening organ dysfunction caused by dysregulated host response to infection
What can sepsis lead to?
Increased capillary permeability - Vasodilatation and hypotension –> underperfusion - Shock Multiple organ failure Cardiovascular collapse Death
What is increased capillary permeability?
Leakiness - fluid seeps out of vessels so blood pressure drops
How can organ dysfunction be represented?
By an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of ≥ 2 If your SOFA score is ≥ 2 then your in-hospital mortality is greater than 10%
What is septic shock?
The worst subset of sepsis (i.e. sepsis can lead to septic shock) Profound circulatory, cellular, and metabolic abnormalities
What are the indicators of septic shock in regards to vasopressor requirement and serum lactate?
Vasopressor requirement to maintain a mean arterial pressure ≥ 65 mm Hg Serum lactate level > 2 mmol/L (in the absence of hypovolemia)
What is the q(quick)SOFA?
Bedside clinical score
Adult patients with suspected infection are more likely to have poor outcomes if they have a qSOFA of at least 2 of what conditions?
Respiratory rate ≥ of 22/min (remember respiratory rate will drop after fatigue after effort breathing) Altered mentation / new confusion Systolic blood pressure ≤ 100 mm Hg
Sepsis pathway:
What organs suffer during multiple organ failure?
Acute lung injury
Cardiovascular instability (hypotension)
Acute Kidney Injury
GI mucosal injury (translocation of bacteria)
Liver dysfunction
Who is most vulnerable to sepsis?
<1 year and >75 years
Very frail people
Recent trauma or surgery or invasive procedure (within 6 weeks)
Impaired immunity (illness, drugs)
Indwelling lines / catheters
IV drug misusers
Any breach of skin integrity (cuts, burns, skin infections)
What is the high risk criteria for sepsis?
- New altered mental state
- Respiratory rate: ≥25 breaths per minute OR
- New need for oxygen
–> 40% FiO2 to maintain saturation more than 92% or
–> 88% in known chronic obstructive pulmonary disease
- Heart rate: ≥ 130 beats per minute (be aware of any drugs patients are on e.g. beta blockers, watch potassium levels)
- Systolic blood pressure ≤ 90 mmHg or systolic blood pressure > 40 mmHg below normal
- Not passed urine in previous 18 hours, or for catheterised patients passed less than 0.5 ml/kg of urine per hour
- Mottled or ashen appearance
- Cyanosis of skin, lips or tongue
- Non‐blanching rash of skin
In response to sepsis, what should you carry out?
Venous blood test
Culture (sputum, urine, wound swab)
In response to sepsis, what should you carry out a venous blood test for?
–blood gas including glucose and lactate measurement
–blood culture
–full blood count
–C‐reactive protein
–urea and electrolytes creatinine
–clotting screen
How should you immediately respond to treating sepsis?
- IV fluids
- IV antibiotics without delay (at least within one hour of identification of high risk criteria)
- Follow local or national guidelines
- Discuss with consultant
