Sepsis and Severe infections Flashcards
What is SIRS?
Systemic inflammatory response syndrome Describes disseminated inflammation in response to a variety of clinical insults.
How is SIRS recognised?
Clinically recognised by the presence of two or more of the following:
Temperature >38.5
Heart rate >90bpm
Resp rate > 20 breaths/min
WCC >12
Define sepsis
SIRS resulting from a documented infection
Define severe sepsis
Sepsis associated with organ dysfunction, hypoperfusion or hypotension.
What is septic shock?
Severe sepsis with hypotension (systolic BP 40 mmHg from baseline) that is unresponsive to adequate fluid resuscitation.
How would you treat a patient you suspected to have severe sepsis?
Sepsis 6
- Give high flow oxygen
- Take blood cultures
- Give empirical IV antibiotics
- Measure FBC and serum lactate
- Give IV fluid resuscitation
- Measure urine output
State how you would assess organ dysfunction for 3 organs
Respiratory failure: Oxygen requirements
Circulatory failure: Low BP, high lactate, mottling
Renal failure: Urine output / Creatinine
CNS: Glasgow coma score
Coagulation: Low platelets, DIC
Liver: Lactate, low glucose
Name two causes of bacterial meningitis
- N. meningitidis
- S. pneumoniae
Also: Group B streptococci
Haemophillus influenzae
Listeria monocytogenes
Mycobacterium tuberculosis.
Name two causes of viral meningitis
Enterovirus, VZV, HIV, mumps, measles
What are the three cardinal symptoms of meningitis?
Fever/headache, neck stiffness, photophobia
Name two causes of encephalitis
HSV, Rabies Also: VZV, HIV, arboviruses
How can you distinguish between a patient with meningitis and encephalitis
Both meningitis and encephalitis present as fever, headache and neck stiffness. In encephalitis because the brain tissue is infection patients also experience reduced consciousness, confusion and seizures
Why is a CT scan sometimes done before a lumbar puncture
Suspected mass or fluid raising intracranial pressure, could cause cerebellar herniation. Unconscious patients
What investigations are done in patients with CNS infections?
WCC
Blood cultures
Blood tests for antigen/PCR
Urine analysis for antigens
Throat swabs
Serology
CSF analysis from lumbar puncture
How is CSF analysed to determine cause of meningitis?
Cloudy appearance = bacterial meningitis
WCC: mostly neutrophils = bacterial, mostly lymphocytes = viral or TB
High protein = bacterial or TB meningitis
Low blood glucose = bacterial or TB meningitis