Sepsis and Septic Shock Flashcards
What is sepsis?
Systemic illness caused by microbial invasion of normally sterile parts of the body?
What is SIRS?
Systemic inflammatory response syndrome
What is septic shock?
Clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP >65 and having a serum lactate of >2mmol/L despite adequate resuscitation
What are the features of the qSOFA score?
Hypotension systolic BP <100mmHg
Altered mental state
Tachypoea RR>22/min
What qSOFA score suggests a greater risk of a poor outcome?
More than or equal to 2
What are the body’s physical defences agains sepsis?
Skin
Mucosa
Epithelial lining
How does the body’s innate immune system defend against sepsis?
IgA in gastrointestinal tract
Dendritic cells
Macrophages
How does the body’s adaptive immune system defend against sepsis?
Lymphocytes
Immunoglobulins
What are the 3 stages of the pathogenesis of sepsis?
Release of bacterial toxins
Release of mediators
Effects of specific excessive mediators
What are the commonly released bacterial toxins during the 1st stage?
Lipopolysaccharide (gram +)
Microbial associated molecular pattern (gram -)
Superantigens
What are the 2 types of mediators that are released in the 2nd stage?
Pro-inflammaatory mediators
Compensatory anti-inflammatory reaction
What do pro-inflammatory mediators cause?
Inflammatory response that characterises sepsis
What does the compensatory anti-inflammatory reaction cause?
Immunoparalysis
What are the effects of the pro-inflammatory mediators?
Promote endothelial cell-leukocyte adhesion Release of arachidonic acid metabolites Vasodilation of blood vessels by NO Increase coagulation Cause hyperthermia
What are the effects of the anti-inflammatory mediators?
Inhibit TNF alpha
Augment acute phase reaction
Inhibit activation of coagulation system
Provide negative feedback mechanism to pro-inflammatory mediators
What are the general features of sepsis?
Fever >38 c (presents as chill, riggers, flushes, cold sweats, night sweats) Hypothermia <36 c Tachycardia >90bpm Tachypnoea >20/ min Altered mental state Hyperglycaemia >8mmol/L
What are the inflammatory variable in sepsis?
Leucocytosis (WCC>12000/ml) Leucopenia (WCC<4000/ml) Normal WCC with more than 10% immature forms High CRP High procalcitonin
What are the haemodynamic variables in sepsis?
Arterial hypotension (systolic <90mmHgor MAP <70mmHg) SvO2> 70%
What are the organ function variables in sepsis?
Arterial hypoxaemia (PaO2/FiO2 <50mmHg)
Oliguria (0.5ml/kg/h)
Creatinine increase compared to baseline
Coagulation abnormalities (PT>1.5 or APTT>60s)
Ileus
Thrombocytopenia (<150000/ml)
Hyperbilirubinaemia
What are the tissue perfusion variables in sepsis?
High lactate
Skin mottling
Reduced capillary perfusion
What effect can the host have on the presentation of sepsis?
Age
Immunosuppression
Splenectomy
What is the sepsis 6?
Blood cultures
Blood lactate
Measure urine output (Take 3)
Oxygen aim sats 94-98%
IV antibiotics
IV fluid challenge (Give 3)
What is type A lactate caused by?
Hypoperfusion
What is type B lactate caused by?
Mitochondrial toxins
Alcohol
Malignancy
Metabolism errors
How much fluid should be given for sepsis?
30ml/kg
When should you consider HDU referral?
Low BP responsive to fluids Lactate >2 despite fluid resuscitation Elevated creatinine Oliguria Liver dysfunction Bilateral infiltrates, hypoxaemia
When should you consider ITU referral?
Septic shock
Multi-organ failure
Requires sedation, intubation, ventilation
