Sepsis - Complications

Question 1

What is sepsis?

Answer 1

A life-threatening organ disfunction caused by disregulation of the host response to infection. aka AN EXTREME BODY RESPONSE TO INFECTION.

Question 2

When does sepsis occur?

Answer 2

Occurs when an infection (at any site) initiates a systemic sequence of events.

Question 3

Most common sites that sepsis arises from (4).

Answer 3

• Lung.
• Skin.
• GI.
• Urinary.

Question 4

What is septic shock?

Answer 4

Subset of sepsis where underlying CIRCULATORY and CELLULAR or METABOLIC abnormalities are profound enough to increase mortality substancially.

DIFFERENT/ SEPARATE ENTITY FROM SEPSIS?? (not everyone with sepsis has septic shock).

Question 5

Why is sepsis important?

Answer 5

• RAPID and PROGRESSIVE.
• Can progress to ORGAN FAILURE and DEATH.

Question 6

What age group is more likely to develop sepsis?

Answer 6

• Older patients far more likely to be affected.
• 65 and older make 12% of the population but 65% of sepsis cases.
• 2.3 times more likely to die if sepsis at 65.

Question 7

Why is sepsis less common in women?

Answer 7

Effect of sex hormones on immunity and the cardiovascular response to cytokine signalling.

Question 8

Why are non whites more at risk of sepsis?

Answer 8

• Access to care/ poverty.
• Comorbidities (HIV, diabetes, kidney disease, substance misuse).
• Potential genetic factor in Africans.

Question 9

Why are solid organ transplant patients more at risk of sepsis?

Answer 9

• Immunosupressed.

Question 10

Modifiable factors (2) for sepsis risk?

Answer 10

• Alcohol.
• Smoking (less robust - may be associated with comorbidities that smoking is associated with).

Question 11

What is the most common origin site of sepsis?

Answer 11

• Lungs (64%)
• Abdomen, bloodstream, renal or genitourinary tract.

Question 12

Microbiology of sepsis?

Answer 12

• 47% gram positive (S. aureus 20%).
• 62% gram negative (20% Pseudomonas spp and 16% E coli).
• 19% Fungal.

Question 13

What is the assessment for sepsis?

Answer 13

Patient presents with A SOURCE OF INFECTION and TWO OR MORE:
- Temperature: Increased temperature (>38) OR decreased temperature (<36).
- Heart rate: >90 (high risk >130).
- Respitatory rate: >20 (high risk >25).
- BP systolic: <100 (high risk <90).
- WCC >12 or <4.

Question 14

8 sepsis red flags?

Answer 14

• Altered mental state/confusion.
• Unable to stand/collapse.
• Unable to catch breath/speak.
• Fast breathing.
• Skin pale, mottles, ashen or
  blue.
• Rash won’t fade.
• Recent chemotherapy
• Oliguria (not passed urine in past 18 hours).

Question 15

Sepsis amber flags?

Answer 15

• Behaviour change/reduced
  activity
• Immunosuppressed
• Trauma, Surgery/procedure
  last 8 weeks
• Breathing harder than normal.
• Reduced urine output.
• Temp <36oC
• Wound infection
• No Urine 12-18 hours

Question 16

SEPSIS acronym?

Answer 16

• Slurred speech
• Extreme shivering
• Passed no urine in a day
• Severe breathlessness
• Illness so bad feel they’re dying
• Skin mottled/discoloured/ashen
• Rash doesn’t blanch with pressure
• cyanosis of lip/skin/tongue.

Question 17

How to manage sepsis?

Answer 17

BUFALO
- Blood cultures + Septic screen, U&E’s (2)
- Urine output - monitor hourly (6).
- Fluid resuscitation (4)
- Antibiotics IV (microbiology) (3)
- Lactate measurement (5)
- Oxygen – to correct hypoxia (1)