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Sepsis > Sepsis Form > Flashcards

Sepsis Form Flashcards

1
Q

What is Sepsis?

A
  • It is a serious life threatening condition.
  • left untreated and not being detected asap, can lead to shock or even death.
  • this is where there is a presence of a harmful microorganisms in the organs, blood or in the tissues.
  • there presence can lead to malfunctions of various organs.
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2
Q

What are symptoms of Sepsis?

A

SIRS
- Spiking temp
- Increase HR, RR decrease Urine output
- Rigor/chills
- skin pallor/rashes

Addition
- fever and chills
- low body temp
- rapid pulse and breathing
- less urination
- nausea & vomiting
- diarrhea

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3
Q

What to check if INEWS score is >/= 4 ; >/=5 in oxygen and suspicion of infection

A

Check Sepsis 6 treatment bundle.

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4
Q

What is the Sepsis 6 treatment bundle?

A

Check 3 of the ff.

  1. Risk of Neutropenia
  2. Clinical evidence of new onset of organ dysfunction
  3. Systemic Inflammatory Response syndrome ( SIRS ) 2 or more + 1 or more co-morbidities
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5
Q

Any of the following for clinical evidence for new onset of organ dysfunction?

A
  • acute altered mental state
  • HR >130bpm
  • RR >30bpm
  • SBP <90mmHg
  • O2 sat <90
  • Oliguria/Anuria
  • non-blanching rash
  • pallor/mottling with prolonged capillary refill
  • other organ dysfynction
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6
Q

2 or more SIRS?

A
  • HR >90bpm
  • RR >20bpm
  • temp <36 or >38.3 °C
  • WBC <4 or >12x
  • bedside glucose: >7.7mmol/L
  • acute altered mental state
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7
Q

1 or more co-morbidity
( a presence/having 2 or more diseases/medical conditions )

A
  • cancer
  • COPD
  • chronic kidney disease
  • chronic liver disease
  • DM
  • HiV/AiDS
  • immunosuppressant meds
  • frailty
  • > 75 y.o
  • recent surgery
  • major trauma
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8
Q

What are sites of infection?

A
  • CNS
  • skin
  • respi tract
  • intra-abdominal
  • intra-articular/ bones
  • urinary tract
  • catheter / devices
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9
Q

If 1.2.3 are ticked?
What to do next if there is End of Life plan?

A

No need to proceed to sepsis 6.

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10
Q

If 1.2.3 are ticked?
What to do next if there is no End of Life plan?

A

Proceed to sepsis 6

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11
Q

What’s in the sepsis 6?

A

The Take 3 and Give 3

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12
Q

What are the Take 3?

A
  1. Take blood cultures
  2. Take blood tests
  3. Take urine output assessment
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13
Q

What are the Give 3?

A
  1. Give antimicrobials
  2. Give fluids
  3. Give oxygen
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14
Q

Discuss Take -blood cultures._

A
  • take blood cultures using aseptic technique (no touch) technique prior giving antimicrobial unless it will delay for >45mins.
  • other cultures test was done in history and assessment
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15
Q

Discuss Take Blood Test

A
  • point of care lactate (which is a test to identify sepsis or severe infection) cab be taken either from venous or arterial.
  • take cbc
  • take renal and liver function test
  • take coagulation test
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16
Q

Discuss Take urine output assessment

A
  • Consider urine output as part of the volume/perfusion status assessment.
  • px is having sepsis/in septic shock. Start fluid balance sheet.

-catheterized px if indicated

  • monitor/measure urine output hourly
17
Q

Discuss Give antimicrobial

A
  • in giving antimicrobial, follow the local guidelines in antimicrobial administration
  • consider the site and the source of inf ( community acquired or healthcare acquired)
  • consider the allergy status of the patient.
  • assess requirement for source control.
18
Q

Discuss Give IV fluid

A
  • hypotension…give 39ml/kg of Isotonic crystalloid sol (e.g. NS or LR)
  • if unresponsive to fluid… give Vassopressor ( vasocontrictor e.g. norepeniphrine )
  • hypo-perfusion (reduced blood flow) give fluid 500ml bolus within 15mins to 2 hrs.
  • bolus may be amended or change accdng to clinical context.
  • see fluid resuscitation algoritm
  • no response to fluid… call aneathesiologist or critical care
19
Q

Discuss Give oxygen

A
  • oxygen will be given if necessary.
  • titrate/adjust the measurement of oxygen to achieve a 94-96% to normal adults
    Or 88-94% to those who have chronic lung disease
20
Q

Evidence of infection or new onset of organ dysfunction

A
  • lactate > 4mmol/L after 30ml/kg IVF therapy
  • BP
    <90mmHg SBP
    <65mmHg MAP
    >40mmHg SBP below normal
  • Respi
    new need for oxygen to achieve a saturation of 90%
  • Blood tests
    creatinine >170
    bilirubin >32
    platelets <100
  • urine output
    <0.5ml/kg for 2H with adequate fluid resus
  • acute altered mental state

Sepsis (1 decks)

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