Sepsis Flashcards
What is sepsis?
Sepsis is a life-threatening reaction to an infection.
It happens when your immune system overreacts to an infection and starts to damage your body’s own tissues and organs.
Sepsis is sometimes called septicaemia or blood poisoning.
Who are the at risk groups?
Babies under 1, particularly if they’re born early (premature) or their mother had an infection while pregnant
- People over 75
- People with diabetes
- People with a weakened immune system, such as those having chemotherapy treatment or who recently had an organ transplant
- People who have recently had surgery or a serious illness
women who have just given birth, had a miscarriage or had an abortion
Can you catch sepsis from someone else?
You cannot catch sepsis from another person. It happens when your body overreacts to an infection.
What are the signs and sympotms of sepsis in children
-blue, pale or blotchy skin, lips or tongue
- a rash that does not fade when you roll a glass over it, the same as meningitis
- difficulty breathing (you may notice grunting noises or their stomach sucking under their ribcage), breathlessness or breathing very fast
-a weak, high-pitched cry that’s not like their normal cry
-not responding like they normally do, or not interested in feeding or normal activities
-being sleepier than normal or difficult to wake
People may not have all of these symptoms
What are the signs and sympotms of sepsis in adults
- acting confused, slurred speech or not making sense
- blue, pale or blotchy skin, lips or tongue
- a rash that does not fade when you roll a glass over it, the same as meningitis
- difficulty breathing, breathlessness or breathing very fast
When should you call 111 if you suspect sepsis
You, your child or someone you look after:
feels very unwell or like there's something seriously wrong has not had a pee all day (for adults and older children) or in the last 12 hours (for babies and young children) keeps vomiting and cannot keep any food or milk down (for babies and young children) has swelling, redness or pain around a cut or wound has a very high or low temperature, feels hot or cold to the touch, or is shivering
In which demographics is sepsis particularly hard to spot
babies and young children
people with dementia
people with a learning disability
people who have difficulty communicating
Describe how a sepsis response affects the body’s blood supply and organs
Sepsis is a potentially life-threatening condition. In sepsis, the body’s immune system goes into overdrive as it tries to fight an infection. This can reduce the blood supply to vital organs such as the brain, heart and kidneys. Without quick treatment, sepsis can lead to multiple organ failure and death.
Define the following terms: Pyrexia Pallor Tachycardia CRP WCC
Pyrexia (raised body temperature; fever)
Pallor (an unhealthy pale appearance)
Tachycardia (markedly elevated resting heart rate)
Raised infection markers in blood
CRP (c-reactive protein), WCC (total white cell count)
Define severe symptoms (using medical criteria)
Severe sepsis: “Sepsis PLUS sepsis-induced organ dysfunction or tissue hypoperfusion”
Low urine output (<0.5ml/kg/hr) Low arterial oxygen concentrations Changes in blood clotting time (INR >1.5) Raised bilirubin (>70micromol/L) Raised lactate (>1mmol/L)
What criteria does NICE use to stratify sepsis risk
History, respiratory, blood pressure, circulation and hydration, temperature and skin
An infection in which areas of the body can lead to sepsis
Any type of infection can lead to sepsis. Some more common ones are lung infections, UTI, gut infection, skin infection
What is the castcade from infection to death via sepsis
infection, sirs (systemic inflammatory resopnse syndrome), sepsis, severe sepsis, septic shock, death
What are the risk factors for sepsis
Immunocompromise HIV infection Cancer chemotherapy Neonates and infants Chronic disease Recent surgery - associated with ssis Invasive procedures Central lines Urinary catheters
What is the mortality percentage of a patient with septic shock
50%!
Detail the pathophysiology of sepsis (the cellular response)
Septic shock relates to a deregulated inflammatory response
Bacterial proteins (or fungi, protozoa, viruses etc.) activate cellular defence mechanisms
Release of inflammatory cytokines
TNF, Interleukin-1 and -6
Nitric oxide release
triggers vasodilation
Activation of complement
Cell recruitment (leucocytes, macrophages and lymphocytes)
There is a good infographic in the lecture
How time crucial is the treatment of sepsis
The first hour is absolutely key to the outcome of a patient with sepsis. If treatment isn’t instituted within the first hour, mortality increases by almost 10% for every hour it is delayed.
What is the problem surrounding delayed diagnosis
Sepsis is incredible time sensitive. It can be very effectively treated if its caught early (if caught within the first 50 minutes survival is up at 80%) However, the longer it’s left the less likely survival is
What is the sepsis 6?
The Sepsis Six is an initial resuscitation bundle designed to offer basic
intervention within the first hour.
They are:
administer oxygen, take blood cultures, give IV antibiotics, give IV fluids, check serial lactates, measure urine output
What are the goals of each of the sepsis 6?
Oxygen:
Increase blood Oxygenation
Increase oxygen delivery to organs
Blood Cultures:
Start smart, then focus
Broad Spectrum Antibiotics:
Treat infection
Fluid Resuscitation:
Restoration of circulating fluid volume
Improving tissue perfusion
Lactate:
A marker of anaerobic respiration
Indicates tissue hypoxia
Monitoring Urine Output:
A marker of kidney function
A good marker of tissue perfusion
What are the indicators we’re looking for that the interventions are working for each of the sepsis 6
Oxygen:
Decreasing lactate levels demonstrate there is a higher venous oxygen saturation
Blood clutures:
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Broad Spectrum Antibiotics: Inflammatory markers (CRP, Temperature) Infection markers (WCC)
Fluid Resuscitation
Lactate
Venous oxygen saturation
Urine output
Lactate
Normal reference range 0.5 – 2mmol/L
Monitoring Urine Output
Creatinine is a poor marker of Acute Kidney Injury
A urine output of >0.5ml/kg/hr is good
What are the treatments we use to carry out each of the sepsis 6
Oxygen - 100% oxygen through face-mask (=24L/min flow)
Blood cultures - Empirical therapy based on likely organism
Respiratory – G+ve (Staph, strep)
Abdominal – G+, G-, Anaerobes (E.coli, Klebsiella)
Neutropenia – G+, G- (Pseudomonas)
Broad Spectrum Antibiotics
Depends on what you’re treating
“Empirical therapy” for the first 48hrs
Fluid Resuscitation
Physiological saline - 0.9% sodium chloride infusion given AS FAST AS POSSIBLE
Blood and plasma
Monitoring Urine Output
Clearing the fluid administered to resuscitate the patient
What is empirical therapy
Start smart - maximum dose maximum frequency of a broad spec antibiotic based on the likely organism
Then focus - once the cultures are back use a more appropriate, narrow spec antibiotic
Which antibiotics do we use at the begining of empirical therapy
-G+ and G- cover at first
3rd generation cephalosporin (e.g. ceftriaxone)
Macrolide (e.g. clarithromycin) if penicillin allergic
-Neutropenia
Use broad spectrum penicillin (piperacillin)
greater Pseudomonas cover
Add in aminoglycoside (enhanced G- cover)
SINGLE DOSE – renal sparing
-Acute abdomen
Add in metronidazole (anaerobes)
