Sepsis + shock Flashcards
Define sepsis
Life-threatening organ dysfunction that occurs due to dysregulated immune response to an infection
Describe the criteria for sepsis
Use qSOFA
- Reduced GCS
- Increased RR (22+)
- Hypotension (<100)
Define septic shock
Sepsis with significant circulatory compromise, can be identified clinically as patients requiring vasopressors + lactate >2mmol/L
Describe the risk factors for sepsis
- Older age
- Frailty
- Immunosuppressed, HIV, alcoholics
- Hospitalisation: indwelling lines, recent surgery etc
What are the common sources of infection in sepsis?
Urinary tract very common (urosepsis)
Resp tract
Blood (septicaemia)
Abdo (intra-abdominal, biliary sepsis)
Describe the presentation of sepsis
- Acute deterioration with infection
- Fever, focal symptoms
- Tachycardia, tachypnoea, hypoxia
- Pale, cold peripheries, weak pulses
- Hypotension
- Reduced urine output
Describe the investigations for sepsis
If suspected:
- Urine dip + MCS
- Bloods: FBC, CRP, U+Es, LFTs, culture, VBG/ABG
- CXR
- Others as indicated eg. LP, CT head
Describe the management of sepsis
A to E
Admit, senior review
Sepsis 6:
-Take: lactate, blood cultures, measure urine output
-Give: high flow O2 (target sats 94-96), IV fluids + ABx
Monitor, be aware of need for vasopressors/ITU
Describe the complications of sepsis
- AKI + complications
- Acidosis
- ARDS
- Multi-organ dysfunction
- DIC
What is febrile neutropenia? Who is at risk?
A fever >38.3 in a neutropenic patient (ANC <500). Implies infection that has a very high risk of sepsis + mortality
RFs: patients on chemotherapy (esp haem malignancy)
Describe the presentation of febrile neutropenia
Fever >38.3
May not have any localising symptoms/signs
Describe the investigations + management of febrile neutropenia
Important to look for source of infection eg. swabs, skin examination, CXR, blood cultures, urine Management: -Admission -Sepsis 6 -BS antibiotics eg. Tazocin -Consider G-CSF
Describe multi-organ dysfunction syndrome
Dysfunction in 2+ organ systems that occurs in acute illness eg sepsis, burns, trauma. May include:
- AKI
- Liver failure eg. bleeding, encephalopathy
- DIC
- ARDS
Describe the management of multi-organ dysfunction syndrome
- ITU
- Supportive Mx: fluids, I+V, haemodialysis, etc
- Manage underlying cause: IV ABx, etc
Define shock. What are the types of shock and what are some causes of each?
A life-threatening condition caused by inadequate tissue perfusion.
Hypovolaemic: haemorrhage, dehydration, pancreatitis
Septic: sepsis
Cardiogenic: cardiac (ischaemia, arrhythmia, cardiomyopathy), resp (tension PT, PE)
Anaphylactic
Describe the presentation of the different types of shoc
Hypovolaemic: patient is dry, cool. JVP low.
Septic: patient is warm, dry. JVP low
Cardiogenic: patient is cool, overloaded. JVP raised
Anaphylactic: signs of anaphylaxis
Describe the management of shock briefly by type
Hypovolaemic: fluid resus
Septic: fluid resus + IV ABx
Cardiogenic: dobutamine
Anaphylaxis: IM adrenaline
Describe the management of hypovolaemic shock (more detailed)
A to E
- High flow O2 if low sats
- IV access, bloods + fluid resus
- IV fluid bolus: 500mls crystalloid over 15 mins. Repeat as needed. Senior needed if giving >2L
- Investigate cause eg. bleeding
Describe the management of septic shock
Manage as per sepsis.
Probably needs ITU + vasopressors
Describe the management of cardiogenic shock
A to E
- High flow O2 if low sats
- ECG, IV access, bloods
- Treat any cardiac abnormality eg. arrhythmia -> DCCV, MI -> reperfusion
- CXR/CTPA
- > dobutamine
Describe the indications for:
- Dobutamine
- Dopamine
- Noradrenaline/adrenaline
Dobutamine: used in cardiogenic shock. Increases cardiac contractility + vasodilation
Dopamine: used in cardiogenic shock. Increases cardiac contractility + vasoconstriction + improves blood flow to kidneys.
Noradrenaline: used in septic shock. Causes vasoconstriction primarily.
