Sepsis Flashcards
Why is sepsis important?
- It’s common
- 49 million cases/year globally
- 20% of all global deaths
- High morbidity and mortality
- 5 people die with sepsis every hour in the UK
- 40% of all sepsis survivors suffer permanent, life-changing after-effects
- Affects all ages
- Community and hospital acquired
- High cost
- Recent challenges and increased susceptibility
What are the risk factors for sepsis?
Risk Factors • Elderly (>75 years) and very young (<1 year) • Impaired immune system • Surgery in last 6 weeks • Breach of skin integrity • IV drug users • Indwelling lines or catheters • Pregnancy, given birth or had miscarriage/termination of pregnancy in previous 6 weeks • Diabetes • Asplenic
What are the causes of sepsis?
Anything really! • Neisseria meningitidis • Streptococcus pneumoniae • Streptococcus pyogenes • Staphylococcus aureus (including MRSA) • Salmonella typhimurium • Klebsiella pneumoniae • Gram negative bacilli • Candida species • Encapsulated organisms (asplenics) ...Prevention is better than cure
What do sepsis be?
“Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection”
In lay terms, sepsis is a life- threatening condition that arises
when the body’s response to an infection injures its own tissues and organs.
What are some alternate definitions of sepsis?
Colonisation
• Presence of a microbe in the human body that does not cause infection or a specific immune response.
Infection
• Occurrence of inflammation due to the presence of a microbe. Septicaemia
• Presence of viable microbes in the blood.
What is SIRS?
- Systemic Inflammatory Response Syndrome
- Patient with 2 or more of the following criteria:
- Temperature ≥38°C or <36°C
- HR >90 bpm
- RR >20/min (PaCO2 <32mmHg/4.3 kPa)
- WBC >12000/mm3 or <4000/mm3
- Source of infection
What is a SOFA score?
Sequential Organ Failure Assessment
SOFA score with an increase of ≥2 indicates sepsis with a suspected or documented infection
What is a qSOFA score
• For rapid assessment of potential sepsis prior to investigations • Score of ≥2 of: Respiratory rate ≥22/min Systolic blood pressure ≤100mmHg Altered mental state (GCS <15)
What does the NEWS/FEWS chart provide in terms of clinical analysis of sepsis?
Provides method of: • Collating observations • Viewing trend • Easy handover/transfer of information • Early recognition and escalation
What is the sepsis 6?
(Within 1 hour of recognition)
Take 3
• Blood cultures
• Lactate (bloods)
• Urine output (catheterisation)
Give 3
• Oxygen
• IV fluid
• IV antibiotics
Does a sepsis diagnosis necessitate senior advice?
YES • Call early for help and senior advice • Expert involvement • Infection control • Infectious diseases • Public health
What further investigations should be performed for sepsis?
• Bloods • Inflammatory makers (CRP, WCC) • FBC, U&Es, LFTs • Clotting • Platelets • Procalcitonin • Arterial Blood Gas • Chest x-ray • Urinalysis • ECG • Microbiology • Cultures – sputum, urine, stool, wound swab, tissue, CSF, ascitic fluid, joint fluid, pleural fluid • Virology • SARS-CoV-2 • NAAT/PCR • Serology • Hepatitis, HIV • Echocardiogram • CT
What is septic shock?
“Septic shock is a subset of sepsis in which underlying circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone”
What is the clinical criteria for septic shock?
- Sepsis
- Hypotension requiring vasopressor therapy to maintain mean BP ≥65 mmHg
- Serum lactate >2 mmol/L despite adequate fluid resuscitation
Review the process performed when a septic patient comes in
• Senior Assistance
- Antibiotics
- Culture results including sensitivities
- Correct antibiotic, dose and route
- Source control
- Abscess
- Deep infection
- Medical device with biofilm
- New infection
