Sepsis Flashcards
Define sepsis
infection, documented or suspected, with some of the signs and symptoms of an inflammatory response
Define septic shock
severe sepsis plus acute circulatory failure characterized by persistent arterial hypotension despite adequate volume administration
Causes of sepsis related to pregnancy
- Chorioamnionitis
- Postpartum endometritis
- Septic abortion
- Septic thrombophlebitis
- Puerperal sepsis
- Infection of cesarean section wound
- Episiotomy infection
- Necrotizing fasciitis
- Pelvic abscess
- Infected cerclage
- Amniocentesis - septic abortion
- Umbilical cord biopsy
Non-pregnancy related causes of sepsis in pregnancy
UTI Pyelonephritis Malaria Hepatitis Listeriosis Pneumonia TORCH Iatrogenic
Most common organisms causing sepsis in pregnancy and postpartum:
E.coli Ureaplasma Mycoplasma S aureus MRSA Flu Covid-19
Antibiotic of choice for septic pregnancies?
Vancomycin, or piperacillin-tazobactam (zosyn)
Key principles of sepsis management
Antibiotics
Fluids
Vasopressor
Steroid (if no response to vasopressor)
Nutritional support (early enteral feeding)
DVT ppx
Avoid hyperglycemia (glucose less than 180mg/dL)
How do you manage septic patients?
- IV fluid administration w/in first 3 hours (30 ml/kg crystalloid)
- Administer broad spectrum antibiotics
- Obtain cultures
- Obtain lactate
- Optimize position
How do you manage pyelonephritis?
Admit patient (until 24-48 hours afebrile) IV Cefazolin or Ceftriaxone PO antiobiotics x 7-14 days Antibiotic suppression Renal US if fever persistent Trend CBC
What is the 1-hour bundle?
1) Measure lactate level.
2) Obtain blood cultures before administering antibiotics. (draw from 2 sites)
3) Administer broad-spectrum antibiotics.
4) Begin rapid administration of 30mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.
5) Apply vasopressors if hypotensive during or after fluid resuscitation to maintain a mean arterial pressure ≥ 65 mm Hg.
In sepsis, poor outcome is defined by: SBP below ____ mmHG and RR is usually higher than _____ bpm with altered mental state.
100 mmHg
22 bpm
Elevated lactate (>4mmol/L) indicates?
Tissue hypoxia
greater than 2mmol/L increases risk for ICU admission
Greater than 4mmol/L increases the risk of death by 50%
How do you assess response to fluid resuscitation?
U/O and BP
What are complications that may develop with a septic patient?
Kidney failure Tissue death (gangrene) Permanent lung damage Permanent brain damage Later problems with immune system Damage to the heart valves (endocarditis)
Types of scoring for sepsis in pregnancy
1) Meows scoring
2) qSOFA score
3) SOS
Systems that are more likely to contribute as source for microbe in sepsis
GU and Lung
Evaluation of maternal sepsis - stepwise approach
Start with a scoring system
