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The Public - Year 2 > Sepsis and Septic Shock > Flashcards

Sepsis and Septic Shock Flashcards

1
Q

Define sepsis

A

an infection with systemic effects

Such as: pyrexia, pallor, tachycardia and raised infection markers in the blood

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2
Q

Define severe sepsis

A
  • low urine output <0.5mL/Kg/hr
  • low arterial oxygen concentrations
  • changes in blood clotting (INR >1.5)
  • raised bilirubin >70µmol/L
  • raised lactate >1mmol/L
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3
Q

Define septic shock

A

sepsis induced hypertension persisting despite fluid resuscitation.
Systolic BP <90mmHg OR Mean arterial pressure 70mmHg

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4
Q

What are the risk factors for sepsis?

A
  • immunosuppression
  • neonates & infants
  • chronic disease
  • recent surgery
  • invasive procedures (e.g. catheters)
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5
Q

What is septic shock?

A

A deregulated inflammatory réponse involved the release of cytokines, nitric oxide, activation of complement and endothelial activation

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6
Q

What does vasodilation cause?

A

A reduction in systemic vascular resistance.

Body becomes fluid deplete, perfusion of tissue is reduced, lactate and tissue ischaemia increase.

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7
Q

Why is the first hour key to the outcome of patients with sepsis?

A

mortality increases by 10% for every hour delayed

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8
Q

What is a rise in lactate a sign of?

A

Organ failure

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9
Q

What are the ‘Sepsis Six’?

A
  1. Administer O2
  2. Take blood cultures
  3. Give broad spectrum antibiotics
  4. Fluid resuscitation
  5. Measure lactate
  6. Measure urine output
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10
Q

What does administering O2 do and how is it given?

A

increases blood oxygenation and increases blood delivery to organs.
- given through a face mask with 100% oxygen

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11
Q

What are the indicators for needing to administer O2?

A

Raised lactate and low venous oxygen

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12
Q

Why is it necessary to take blood cultures?

A

To identify the causative organism so that the correct treatment can be given. Treatment with antibiotics should be continued even when waiting for blood results.

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13
Q

What are the likely organisms to cause a respiratory infection?

A

Gram positive

- staph and step

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14
Q

What are the likely organisms to cause an abdominal infection?

A

Gram positive / negative anaerobes

- E.coli or Klebsiella

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15
Q

What are the likely organisms to cause a neutropenia infection?

A

Gram postive / negative organisms

- Pseudomonas

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16
Q

What are the indicators of infections?

A

Inflammatory markers - CRP and temperature

Infection markers - WCC

17
Q

What kind of cover should be given at first?

A

Both gram negative and positive

  • 3rd gen cephalosprins e.g. cetriaxone
  • macrolides e.g. clarithromycin
18
Q

What should be given for a neutropenia infection at first?

A

Broad spectrum penicillin (e.g. Piperacillin) which gives greater pseudomonas cover
Aminoglycosides for gram negative

19
Q

What should be given for an acute abdomen infection?

A

Metronidazole

20
Q

What should should be given for staphylococci infections?

A
  • Flucloxacillin
  • Rifampicin
  • Vancomycin
21
Q

What should should be given for coliform infection?

A
  • Co-amoxiclav (pen sensitive)

- Carbapenem (pen resistant)

22
Q

What should should be given for pseudomonas infection?

A
  • Ceftazidime (pen sensitive)
23
Q

What is the purpose of fluid resuscitation?

A

To help blood deliver O2 to tissue - restores circulating volume fluid volume and improves tissue perfusion

24
Q

What are the indicators for fluid resuscitation?

A
  • increased lactate
  • decreased O2 saturation
  • decreased urine output
  • low blood pressure
25
Q

What is the treatment for fluid resuscitation?

A

0.9% NaCl

26
Q

When is blood or plasma used for fluid resuscitation?

A

If Hb drops below 7g/L

27
Q

What is urine output a marker of?

A

tissue perfusion

28
Q

Why isn’t creatinine a good marker of tissue perfusion?

A

Takes 3 days to show kidney injury

29
Q

What is lactate a marker of?

A

anaerobic respiration

30
Q

What happens in the body under biochemical stress?

A

The body produces glucose to produce energy, lactate is produced faster than it can cleared and so accumulate .

31
Q

What should be done within 3 hours of a patient presenting with sepsis?

A
  • measure lactate
  • obtain blood cultures
  • broad spec antibiotic
  • 30ml/kg crystalloid or >4mmol/L lactate
32
Q

What are the symptoms of septicaemia?

A
  • fever
  • vomiting
  • limb / joint / muscle pain
  • cold hands and feet
  • pale or mottled skin
  • breathing fast
  • rash
  • sleepy
  • confusion / delirium

The Public - Year 2 (9 decks)

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