Sepsis (A&E) Flashcards
Define sepsis.
Life-threatening organ dysfunction caused by a dysregulated host response to an infection
What is septic shock?
Persistent hypotension requiring vasopressors to maintain mean arterial pressure >65mmHg AND serum lactate >2mmol/L (>18mg/dL)
When do we suspect sepsis?
Suspect sepsis based on acute deterioration in patient in whom there is evidence of infection
What are the common microbial causes of sepsis? (3)
- S. aureus
- Pseudomonas sp.
- E. coli
Describe the pathophysiology of sepsis.
- immune system activation resulting in cellular and humoral responses (cytokines, IL1, IL6, NO, proteases, ROS, complement system)
- endothelial activation (tissue oedema), pro-coagulative state
- vasodilation, increased capillary permeability (decrease in circulative volume) –> tissue dysfunction due to decreased oxygen delivery
What is the SEPSIS 6?
Within 1h of the risk being recognised, TAKE:
- two sets of blood cultures
- serum lactate on a blood gas
- hourly urine output
Within 1h of the risk being recognised, GIVE:
- IV broad-spectrum Abx (after blood cultures)
- IV fluids if evidence of bacterial infection
- oxygen if any sign of circulatory insufficiency
How does sepsis present? (11)
- signs associated with specific infection e.g. cough, dysuria, abdominal pain
- NEWS2: 5+
- temperature - high or low +/- rigors
- tachypnoea
- hypotension
- tachycardia
- altered mental state
- low O2 sats
- oliguria
- poor CRT, mottling, ashen appearance
- cyanosis
What is measured in the NEWS score for sepsis? (6)
- breathing rate: tachypnoea
- temperature: pyrexia
- O2:low oxygen
- BP: hypotension
- HR: tachycardia
- mental status: altered
What are the risk factors for sepsis? (10)
- age >65
- immunocompromised
- indwelling lines or catheters
- recent surgery
- haemodialysis
- DM
- IVDU
- breached skin integrity
- alcohol dependence
- pregnancy
What are the first-line investigations for sepsis? (8)
- TAKE 3: 2x blood cultures, serum lactate, hourly urine output
- FBC, U&Es, serum glucose, CRP, LFTs
- ABG/VBG
- procalcitonin (guides Abx therapy)
- clotting screen
- ECG
- urinalysis
- troponin (raised in chest-source of sepsis due to V/Q mismatch secondary to sepsis –> myocardial ischaemia)
What are some differential diagnoses for sepsis? (10)
- neutropenic sepsis
- non-infectious causes of SIRS (post-op, trauma, burns, transplant, hyperthyroidism, Addisonian crisis etc)
- MI
- pericarditis
- myocarditis
- acute pancreatitis
- massive PE
- leukaemia (fever, leukocytosis, anaemia, tachycardia, multi-organ dysfunction, dyspnoea)
- malignant hyperthermia (>41.1C + muscle rigidity following anaesthetics)
- drug-induced fever and coma
What is neutropenic sepsis? (3)
- high temperature + neutrophil count <0.5x10^9
- in patients receiving cytotoxic chemotherapy
- prophylaxis with fluoroquinolone can be offered
What acronym can be used to remember the investigations and management of sepsis?
SEPSIS 6 - OAFBLU:
Give:
- O2 - aim for 94-96%
- broad-spectrum IV Abx
- IV Fluids - 500ml crystalloid fluid (NaCl or Hartmann’s)
Take:
- Blood cultures - immediately, before Abx started
- serum Lactate - severity of sepsis, metabolic acidosis with raised lactate = potential sepsis
- Urine output hourly
What else can we give for sepsis management, outside of the SEPSIS 6?
Vasopressor (noradrenaline) + inotrope (dobutamine/adrenaline) + corticosteroid (hydrocortisone sodium succinate)
What is the empirical antibiotic of choice for neutropenic sepsis?
Piperacillin with tazobactam (Tazocin)
