sepsis and septic shock Flashcards
What is sepsis
An illness which is caused by an invasion of microbes onto normally sterile parts of the body e.g lungs and brain
What does SIRS stand for
systemic inflammatory response syndrome
What are the signs for suspicion of SIRS
temp >38 or <36
HR >90
RR>20
PaCO2<32
WBC>12000 or <4000
What do you need to have sepsis
SIRS and an infection
What do you need to have severe sepsis
sepsis and end organ damage
What do you need to have septic shock
severe sepsis with hypotension
What is the definition of sepsis
organ dysfunction caused by malfunction of hosts immune response to an infection
What is organ dysfunction classified as on SOFA score
acute change in SOFA score of more than 2 since the infection began
What is the definition of septic shock
Sepsis with persisting hypotension which requires vasopressors to maintain the MAP over 65mmHg and having a serum lactate of more than 2 mmol/l even when having adequate volume resuscitation
What is the qSOFA values
hypotension - systolic less than 100mmHg
Altered mental status
tachypnoea
resp rate higher than 22/min
What score in the Qsofa suggest poor outcomes
more than 2
What is the effect of delaying antibiotic treatment in septic shock
Mortality increases
What is the bodies defence against sepsis
Physical barrier - skin, mucosa and epithelial lining
Innate immune system - IgA in GI, dendritic cells and macrophages
Adaptive immune system - lymphocytes and immunolobulin
How does sepsis occur
The organism needs to break through the skin and get into the blood stream
Describe the pathogenesis of sepsis
Release of bacterial toxins which causes antibodies to respond with mediators that will cause the effect on the organs
What toxins are released by gram negatives in sepsis
LPS - lipopolysaccharide
What toxins do gram positives release in sepsis
Microbial associated molecular pattern - Lipoteichoic acid and muramyl dipeptides
Super antigens - TSST (staphylococcal toxic shock syndrome toxin) and streptococcal exotoxins
How do the mediators work in sepsis
Pro-inflammatory mediators are released which cause inflammation characteristic of sepsis
Then anti-inflammatories for compensation are released which cause immunoparalysis
What can sepsis present with
delerium
tachypnoea
jaundice and high liver enzymes
kidney issues - oliguria and anuria
raised serum creatinine due to urine issues
What is a high D dimer suggestive of
Pulmonary embolism but is raised in any proinflammatory reactions in the body
What are the standard features of sepsis
Fever more than 38
hypothermia less than 36
tachycardia more than 90bpm
tachypnoea more than 20/min
altered mental status
hyperglycaemia over 8mmol/l
How does the fever in sepsis present
chills, rigors, flushes, cold sweats, night sweats
Why is hyperglycaemia caused by sepsis
Body breaks down lipids into glucose for energy to fight infections
Why is lactate important in sepsis
It is caused by anaerobic metabolism so it means that the cells have low oxygen
What is the difference between gram positive / gram negative sepsis
gram positives affect above the diaphragm and gram negatives usually affect lower than the diaphragm
What is the sepsis 6
Take 3, give 3
Take blood cultures, blood lactate and measure urine outpute
Give oxygen (aim for sats above 94%), IV antiviotics and IV fluids
What rate should iv fluids be given
30ml/kg
What is used to identify mortality rate of patient with pneumonia and describe the values
CURB65
C - confusion
U - over 7 mmol/l
R - resp rate more than 30/min
B - low blood pressure systolic less than 90 and diastolic less than 60
65 - age
0-1 low risk
2 - intermeddiate risk
3-5 - high risk
What is the treatment for low severity sepsis
Amoxicillin 500 mg oral
What is the treatment of moderate severity sepsis
amoxiliin 500 mg plus clarithromycin 500mg (oral)
What is the treatment for severe sepsis
co amoxiclav 1.2g IV plus clarithromycin 500mg IV
What is the alternative to amoxicillin in low and moderate severity sepsis
doxycycline - 200mg loading dose followed by 100 mg orally
