sepsis: defining a syndrome Flashcards
colonisation
presence of a microbe in the human body without an inflammatory response
infection
inflammation caused by the presence of a microbe in the human body
bacteraemia
the presence of viable bacteria in the blood
sepsis
life-threatening dysregulated host immune response to infection
you cannot have sepsis
unless you have an infection
tissue damaged by an infection produces
inflammatory mediators which cause the local features of infection and also produces cytokines, leukocytes also detect the pathogen and produce cytokines, the cytokines and inflammatory mediators travel into the blood stream causing the systemic features of infection
local features of infection
heat, pain, swelling, loss of function, redness
presence of cytokines in the blood affects
- bone marrow
- hepatocytes
- hypothalamic
- brain
the affect of cytokines
increases the energy demand on the body
cytokines affect on bone marrow
stimulates red bone marrow to increase white blood cell production called leukocytosis
why might WCC be low in sepsis
because the pathogen causing sepsis can release toxins which inhibit bone marrow
septic shock
is a subset of sepsis with circulatory and cellular/ metabolic dysfunction i.e. it is sepsis which does not respond to adequate IV fluid resuscitation
you cannot have septic shock until
fluid resuscitation ha been attempted and is unsuccessful
why is there a left shift in white cell count
because the bone marrow is trig to rapidly produce white cells so they are immature
systemic symptoms and signs
- severe
- chills/ riggers
- nausea or vomiting
- constipation or diarrhoea
- malaise or anorexia
peritonitis
peritoneal cavity is normally sterile so leakage of the boewel content can cause peritonitis
causes of peritonitis
- perforated duodenal ulcer
- perforated appendix
- perforated diverticulum
- perforated tumour
SIRS
systemic inflammatory response syndrome is a non-specific clinical response which includes 2 or more of the following
- temperature greater than 38 or less than 36
- resp rate greater than 20 beats per minutes
- heart rate greater than 90 beats per minutes
- white blood cell count greater than 12,000 cells/mm cubed or less than 4000 cells/mm cubed
sepsis is
SIRS AND a suspected or confirmed infection
what else can SIRS be caused by
- trauma
- pancreatitis
- burns
septic shock is
sepsis with hypotension refractory to adequate fluid resuscitation i.e. sepsis plus one acute organ dysfunction: renal, respiratory, hepatic, haematological, CNS, unexplained metabolic acidosis, cardiovascular
STOP
is this sepsis?? if yes implement sepsis 6 bundle within the hour
sepsis 6 bundle
Blood culture (also other cultures i.e. urine, joint etc)
Urine outputt
Fluid resuscitation
Antibiotics IV stat
Lactate (also FBCS and biochem)
Oxygen (target saturations 94-98% except in COPD)
SOFA score stands for
Sequential (sepsis related) organ function assessment
SOFA is used predominantly
in ICU
qSOFA is the
quick sofa and can be used elsewhere in the hospital
qSOFA is used for
screening for outcome rather than screening for diagnosis
qSOFA
- RR greater than 22
- Systolic blood pressure less than 100mmHg
- Altered GCS less than 14
1 point for each:
0= mortality less than 1%
1= mortality 2-3%
2 or more= mortality greater than 10%
NEWS score
in a patient with a NEWS score of 5 or more and a known infection/ signs or symptoms of infection and at risk of infection think could this be sepsis and escalate care immediately
physiological parameters included in NEWS score
- resp rate
- O2 sats
- systolic blood pressure
- pulse rate
- level of consciousness
- temperature
