Sepsis Flashcards
What is Sepsis?
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
Pathophysiology of Sepsis
- Pathogens enter the body via the skin, mucus membranes, respiratory tract, GI/GU tract.
- The bacteria start to emit endotoxin and exotoxins.
- This causes an immune response from the body to fight bacterial infections.
- Neutrophils (leucocytes, white blood cells) and macrophages (phagocytes) promote inflammation by the release of cytokines
- The cytokines (IL1) cause an increase in body temperature to decrease bacteria reproduction and increase leucocytes effectiveness
- The excessive amount of cytokines, introduces high concentrations of histamine and nitric oxide (vasodilators)
- These enter the blood stream, inducing local and systemic vasodilation and increase in vascular permeability
- This causes a drop in blood pressure, increase in heart rate
- The vasodilators begin to affect the endothelium lining of the blood vessels
- The bacteria toxins and cytokines cause injury to the endothelium
- The damage exposes tunica media of the endothelium
- Tissue factor is released, activating clotting
- The clotting in the blood vessels leads to small blood clots throughout the bloodstream
- Clots in the blood vessels reduce organ perfusion
- Inducing hypoxia and anaerobic respiration
- Causing the production of lactic acid, making the blood and organs more acidotic
- Capillaries leak fluid into tissue as a result of vasodilation causing oedema
- Unless BP is restored, major organs will be deprived of oxygen
- Patient enters a state of septic shock and multiple organ failure
Differentials to consider for Sepsis
- UTI
- TIA/CVA
- Hypoglycaemia
Risk Factors for Sepsis
- Young children (<1)/ elderly (>75)/ people who are very frail
- People with impaired immune systems due to illness or drugs e.g. chemotherapy/ diabetics/ those who have recently had surgery/ those on immunosuppressant drugs
Signs and Symptoms of Sepsis
- Patient appears clinically unwell
- Lethargic
- Confused
- Headaches
- Vomiting
- Diarrhoea
- Reduced urine output
- Shortness in breath.
- NEWS2 greater than or equal 5
- RR- below 12 or above 20
- Saturation- below 94%
- Systolic blood pressure below 110 or above 220
- HR: below 50 or above 90
- Patients with a reduced GCS/ VPU on the AVPU Scale
- Temperature below or above 37 degrees
Assessment for Sepsis
DRA(c)BCDE
DANGER assessment for Sepsis
- Assess for any potential danger
- Manage any bleeds
RESPONSE assessment for Sepsis
AVPU - assess
AIRWAY assessment for Sepsis
- Clear?
- Correct if compromised
C-SPINE assessment for Sepsis
Is this concern based on MOI?
BREATHING assessment for Sepsis
- Respiration rate?
- Assist with ventilation if required
CIRCULATION assessment for Sepsis
- Heart rate
- Palpable radial pulse
- Oxygen saturations?
- Capillary refill?
- Skin tone
- Correct if necessary
DISABILITY assessment for Sepsis
- Temperature
- Blood glucose
- Blood pressure
- PEARL
- Equal and bilateral air entry
- 12 ECG
- any wheeze?
- Productive cough?
EXAMINATION assessment for Sepsis
- Top to toe – any rashes?
- Patient complaining of any pain?
- Swollen abdomen?
- Obvious signs of injury/ recent operation
Past Medical History?
When did this start?
Management if Sepsis Suspected
If sepsis is suspected, then treat as per JRCALC:
- Correct any ABC problems immediately.
- Provide oxygen therapy for saturations below 94%
- Sodium Chloride 0.9% if BP is 90 systolic or below (500ml – max 2ltrs)
- Paracetamol for pain management or to treat rigors (1g – max 4g in 24 hours)
- Benzylpenicillin if meningococcal disease is suspected - fever, non-blanching rash (1.2g – max 1.2g)
Rapid transfer and pre-alert to A&E, with ongoing management en-route
Dosage of paracetamol for managing sepsis
1g – max 4g in 24 hours
Dosage of Sodium Chloride 0.9% if BP systolic is 90 or below
500ml – max 2ltrs
Benzylpenicillin is given when? And what dosage?
If meningococcal disease if suspected (fever, non-blanching rash)
1.2g – max 1.2g
