sepsis

Question 1

why is sepsis so important?

Answer 1

• it is common
• life threatening
• causes mobidity and mortality

Question 2

what is sepsis?

Answer 2

it is a condition characterized by life threatening organ dysfunction due to a dysregulated host response to infection

inflammation becomes systemic and overwhelming (rather than localised) damaging tissues and organs

Question 3

what is septic shock?

Answer 3

a subset of sepsis - when the patient suffering sepsis goes into shock (catastrophic fall in BP). It causes cellular and metabolic abnormalities e.g. ischaemia and lactate

Question 4

what occurs in inflammtion to cause sepsis?

Answer 4

• vasodilation
• increase BV permeability and capillary leakage
• amplification of immune system

when this goes from local (in vicinity of microbe) to systemic (overwheliming whole body)= sepsis

Question 5

do all infctions result in sepsis?

are all sepsis cases caused by infection

Answer 5

• no - most infections are resolved

it depends on the virility and the health of the patient

• no - inflammation isnt alaways caused by infection, can be caused by truama or autoimmune problems
  e. g. pancreaitis isnt usually caused by infection but can cause sepsis

Question 6

what is the science behind sepsis? the process of sepsis and septic shock etc?

Answer 6

• inflammation = leaky capillaries, this means we reduce blood volume - loss of fluid to tissues- this reduces preload and therefore SV
• inflammation = vasodilation - reduced TPR

BP = SV X TPR X HR

so when. TPR and SV are down the HR increases to compensate

however the heart can only compensate for so long and will eventually decompensate if not treated early :(

Question 7

what is decompensation?

sepcific example to sepsis?

Answer 7

when the diseased syste can no longer compensate e.g. when HR can no lnger mainatin BP

this happens in septic shock - blood pressure falls and delivery of oxygen to organs

this causes hypoxia and therefore ischeamia, this causes anaerobic resp and lactate production and acidiosis

this causes irreversible damage

Question 8

what end organ damage is caused by sepsis?

Answer 8

• kidney failure
• liver - decreased anabolic function
• heart = type 2 MI
• brain - drowsy/confusion

Question 9

what pathophysiology/observations is seen in sepsis?

Answer 9

• raised HR to compensate for drop in BP
• raised RR - mainatin blood pH
• urine output low - try to conserev circulating volume
• bp drop - decompensation due to fall in HR

Question 10

what is used to score observations?

what does it give us?

Answer 10

we use an EWS (early warning score)

often use NEWS (national early warning score)

gives a generalised overview of how sick a patient- no diagnosis

Question 11

what 2 tools do we use to diagnose sepsis?

what is most common?

why is one not used often?

Answer 11

1. QSOFA (quick sequential (sepsis related) organ failure assessement) - meaures 3 components (RR, GCS, BP)
2. red flag sepsis

red flag sepsis is more commonly used

QSOFA can often miss unwell patients until they deteriorate

Question 12

red flag sepsis layout

Answer 12

Question 13

what is the most important treatment for sepsis?

Answer 13

SEPSIS SIX

give 3, take 3

1. give O₂
2. take cultures
3. give broard antibiotic
4. give fluids
5. take blood / lactate (raises during anaerobic resp and can indicate how ill a pateint is)
6. look at fluid output

Question 14

after sepsis six, what else can you do to help treat the septic patient?

Answer 14

monitor closely: onbservations, examinations, investigations

next steps to take: involve senior collegues, refine treatment (find specific microbe from culture to resuce resistance), further investigations