Sepsis and fluid Flashcards
what indicates an adult have a suspected infection?
- respiratory rate is high
- altered mentation
- systolic bp <100MM Hg
what is septic shock?
a subset of sepsis
what does septic shock cause?
profound circulatory, cellular and metabolic abnormaltities
what is lactate a marker of?
anaerobic respiration/ischaemia (not enough blood supply to organs)
what does sepsis cause?
- Endothelial dysfunction
- Coagulopathy
- Cellular dysfunction
- Cardiovascular dysfunction
What happens in multiple organ failure?
- acute lung injury
- Cardiovascular instability (hypotension)
- Acute kidney injury
- gastrointestinal mucosal injury
- Liver dysfunction
who is more vulnerable to sepsis?
- Children <1
- Adults >75
- Frail people
- Patients with recent trauma or surgery/invasive procedure (within 6 weeks)
- Impaired immunity due to illness and drugs
- Patients with indwelling lines/catheters
- Iv drug misusers
- Patients with breach of skin integrity
how to recognise sepsis?
- Consider signs + symptoms
- Be aware that people with sepsis may have non-specific , non localising presentations
e. g just feeling unwell - Pay attention to concerns expressed by the person and family/carer
What puts a patient in high risk criteria?
1.Evidence of new altered mental state
2.Respiratory rate: >25 breaths per minute
3.Need for new O2
e.g 40% FiO2 to maintain O2 saturation higher than 92%
88% O2 sat in known chronic obstructuve pulmonary disease.
4.High heart rate > 130 bpm
What puts a patient in high risk criteria? (cont).
- systolic BP < 90 mmHg
- systolic BO >40 mmHg
- Not passed urine in previous 18 hours
- Mottled or ashen appearance
- cyanosis
- non-blanching rash of skin (could be meningitis)
How to initially respond to sepsis?
Carry out venous blood test for :
- blood gas
- blood culture
- full blood count
- C-reactive protein
- Urea and electrolytes creatine
- clotting screen
2nd test to respond to suspected sepsis?
Culture (sputum, urine, wound swab)
What acronym to follow?
Blood cultures and septic screen
Urine output-monitor hourly
Fluid resuscitation
Antibiotics IV-LTHT guidelines
Lactate measurement-from an arterial or venous blood gas
Oxygen-to correct hypoxia
What acronym to follow?
Blood cultures and septic screen
Urine output-monitor hourly
Fluid resuscitation
Antibiotics IV-LTHT guidelines
Lactate measurement-from an arterial or venous blood gas (>2)
Oxygen-to correct hypoxia (titrate O2)
women composition of water?
45-50%
men composition of water?
50-60%
what maintains oncotic pressure?
Albumin
What happens to albumin in sepsis?
It leaks out into interstitial space as epithelium of capillary is attacked
Normal intracellular Na+ and K+ level?
Na + = 10 mmo/L
K+ = 160 mmo/L
What type of IV fluids do you use?
- Crystalloids
- Balanced crystalloids(more physiological)
- Blood products
What is crystalloid?
water to which solutes have been aded
High NA+ containing fluids
Low sodium fluids
What are examples of blood products?
Packed red cells
Albumin
What does Hartmans solution contain?
Na+ = 131 mmol/L Cl-= 111 mmol/L Lactate= 29 mmol/L Ca2+= 2 mmol/L
What does Sodium chloride solution contain?
Na+ = 154 mmol/L Cl- = 154 mmol/L
