Sepsis and Septic Shock Flashcards
define sepsis?
systemic illness caused by microbial invasion of normally sterile parts of the body
what characterises the systemic inflammatory response?
temp >38c or <36c,
HR >90,
RR >20 or PaCO2 <32,
WBCs >12,000 or <4000
what is severe sepsis?
sepsis + end organ damage
What is septic shock?
sever sepsis + hypotension
what does qSOFA stand for?
quick Sepsis Related Organ Failure Assessment
what does qSOFA assess?
hypotension (<100mmHg),
altered mental status,
tachypnoea (RR >22/min`)
what are the 3 phases in the pathogenesis of sepsis?
release of bacterial toxins,
release of mediators,
effects of specific excessive mediators
general features of sepsis?
fever >38c, rigors, cold sweats, night sweats, or hypothermia, tachycardia, tachypnoea, altered mental status, hyperglycaemia (>8mmol/l)
Inflammatory variables in sepsis?
leucocytosis or
leucopenia,
high CRP,
high procalcitonin
haemodynamic variables in sepsis?
arterial hypotension,
SvO2 >70%
Organ dysfunction variables in sepsis?
arterial hypoxaemia, oliguria, creatinine, coagulation abnormalities, ileus, thrombocytopenia, hyperbilirubinaemia
tissue perfusion variables in sepsis?
high lactate,
skin mottling,
reduced capillary perfusion
what can change the presentation of sepsis?
age, co-morbidites, immunosuppression, previous surgery eg splenectomy, gram +ve or gram _ve, virulence factors, bioburden
what is leucocytosis?
WCC >12,000/ml
what is leucopenia?
WCC <4000/ml
Define thrombocytopenia
platlet count <150,000/ml
Sepsis 6, take 3 ? and give 3 ?
take 3- blood cultures, blood lactate, urine output measurement
Give 3- oxygen, IV antibiotics, IV fluids
Sepsis 6, 2As, 2Bs, 2Cs
A- Air enriched with O2,
Antibiotics after blood culture
B- Blood culture
Blood gas with lactate
C- crystalloid bolus
Catheterdifference between lactate type A and B
A= hypoperfusion B= mitochondrial toxins, alcohol, malignancy, metabolism errors
volume of IV fluids required for sepsis
30ml/kg
when to consider a sepsis patient for HDU?
low BP after fluids, lactate >2 after fluids, elevated creatinine, oliguria, liver dysfunction
when to consider ICU in sepsis patient?
septic shock,
multi-organ failure,
require sedation, intubation and ventilation
