Sepsis Pathophysiology

Question 1

What is sepsis?

Answer 1

A systemic inflammatory response as a result of an infection and is a combination of distributive, hypovolaemic and cardiogenic shock

Question 2

How does sepsis progress?

Answer 2

Systemic Inflammatory Response
Sepsis
Severe Sepsis
Septic Shock

Question 3

What are the causes of sepsis?

Answer 3

• Blood stream infections caused by pathogens (bacteria, fungi, viruses, parasites)
• Respiratory infection or pneumonia

Question 4

What is the pathophysiology of sepsis?

Answer 4

• Infection of host causes release of anti-inflammatory cytokines and there is anti inflammatory response causing:
• Tissue hypoxia
• Increased vascular permeability causes vascular leakage of albumin, water and electrolytes from capillaries into tissues (AKA hypovolaemia)
• Compensatory vasoconstriction as a protective mechanism to maintain tissue perfusion

Question 5

What are the effects of sepsis?

Answer 5

Decreased perfusion and oxygen delivery to organs lead to organ dysfunction, including metabolic acidosis, hypotension, tachycardia, poor CRT, poor urine output, altered mental status
- Decreased cardiac contractility caused by hypoxia, acidosis, hypokalaemia, hypocalcaemia, and hypophosphataemia all cause a reduction in cardiac function

Question 6

What would you expect to see in the airway and breathing assessment of a septic patient?

Answer 6

Tachypnoea, increased depth of breathing, increased respiratory effort, pallor and low saturations

Question 7

What would you expect to see in the cardiovascular assessment of a septic patient?

Answer 7

Tachycardia, hypotension, poor perfusion, mottled, weak pulse volumes, high temperature, reduced urine output

Question 8

What would you expect to see in the disability assessment of a septic patient?

Answer 8

Irritable, lethargy, response to Pain

Question 9

What would you expect to see in the exposure assessment of a septic patient?

Answer 9

Rash, flushed skin, discharging/oozing wound

Question 10

What is the airway intervention for a septic patient?

Answer 10

Ensure patency

Question 11

What is the breathing intervention for a septic patient?

Answer 11

Administer 15 lites of high flow o2 via re-breath mask with reservoir bag

Question 12

What is the cardiovascular intervention for a septic patient?

Answer 12

Early use of an IO needle to ensure adequate fluid resusitation = 10mls/kg
Correction of acid base balance disturbances, electrolyte imbalances, coagulopathies, blood glucose

Question 13

What are the other interventions for a patient with sepsis?

Answer 13

-Early administration of broad spectrum antibiotics
-Collect blood culture
-Measure lactate
- Early inotropes