Sepsis SIRS Flashcards
Sepsis is
A Life threatening syndrome that arises when the boyd’s response to infection injures it’s own tissues organs
4 Key interventions to SIRS
Labs and Diagnostics (CBC, Serum glucose etc.) - When sepsis labs are drawn it NEEDs to include blood cultures AND lactate
Begin Pt on broad spectrum antibiotics (IV) then more specific
IV Fluid Bolus (Rapid admin of IV fluid) 30mLs/Kg
Monitering
SIRS Criteria
Does the pt have any two or more of the follow SIRS criterea, AND if they have a suspectd/confirmed source of infection if so, they are at risk of developing sepsis
HR greater than 90BPM
RR greater than 20BrPM
Temp Greater than or equal to 38C or less than 36C
WBC greater than 12.0 or less than 4.0 (x10-9)
Altered Mental status (i.e. GCS)
How dangerous is Sepsis
SIRS 7% mortality
Sepsis 16%
Severe Sepsis 20%
Septic Shock 46%
How to objectify altered cognition
Glascow Coma scale
Septic Shock
A subset of sepsis
When sepsis does not respond to intervention
Characterised by consistent HOTN depsite adequeat fluid reuscitation and inadequate tissue perfusion (Bloodflow) resulting in tissue hypoxia
Mismatch bw O2 supply and demand
1/5 people in the world that die are from
Sepsis related
What is the most important thing in ttrearting sepsis
Speed is life
Key goals when recognixing and responsding to sepsis in pts
Timely recognition of early infection
Early treatment with antibiotics/IV fluids
Appropriate escalation to high acuity/ICU
Normal Inflamm response
Defence against injury, injuction or allergens
Localized inflammation
Results in Tissue repair
Inflammatory cascade
In
SIRS stands for
Systemic Inflammatory Response syndrome
SIRS
Exaggerated inflammatory response
A warning sign of a looming crisis
(Pre-sepsis criteria)
Non-specific response to infectious AND non-infectious insults
How do we identify if a pt might haver a suspected source of infection
Symptoms such as
Cough/sputum/chest pain/shortness of breath
Abdominal pain/distension/vomiting/diarreah
Dysuria/frequency/indwelling catheter
Skin or joint pain/swelling
Central Line
Mottled skin/cold extremities
Why is blood taken if systemic infection is supsectedq
BC if a local infection turned systemic it likely would have travelled vbia blood stream
SIR vs SEPSIS
If a suspected or known pathogen is identified then it is diagnosed as SEPSIS
Increas
Pts more at risk for SEPSIS
Older pts, the very young
Immunosuppressants (i.e. corticosteroids)
Pts with multiple chronic comorbidies
Pts w/ invasive devices in (Peritoneal, catheter, central line etc.)
Infection source examples
Lungs - i.e. pneumonia
Urinary Tract -
Abdomen-
Skin and Soft Tissue
Central Lines
Peritoneal
Etc.
What is Sepsis
When some type of infection develops into a systemic inflammatory response
Septic Shock
Severe sepsis w/ HOTN that does NOT resolve despite IV fluid resuscitation
HOTN defined as
Systolic BP less than 90mm Hg and or Lactate greater or = to 2.0 mmol/L
MAP (Mean arteriole pressure) : less than 65 mm Hg
What lab cultures do we ALWAYs need to ensure are drawn in query sepsis?
Blood culture, venous blood gas and lactate
Also a CBC, CRP, Procalcitonin, arteriole blood gas (meausres blood pH), glucose level
A specific sample if source location suspected (I.e urine sample if catheter is present)
MAP
Mean average pressure in pts arteriers during one cardiac cycle, better indicator of tissue perfusion than systolic pressure
What is lactate
A chemical produced by body to fuel the body during stress, commonly asscoiated with sepsis
An important indicator of a septic pts progress (and effectiveness of the treatment)
Over 4 is associated with mortality of 25%
2 Types of lactate
L Lactate (Associated with sepsis)
In the presence of sepsis, lactate is produced as cellular fuel, resulsting from aerobic and anaerobic sources
Ideally antibiotics are started within an ___ of diagnosis
an hour
What type of antibiotic will be given first
Broad spectrum, tho narrowed by source if it is obvious/suspected
How long do you wait to administer IV antibiotics if blood cultures arent yet drawn?
30 mins
If shock is suspected, when are antibiotics given?
For sure within an hour
if no hour, possibly within 3 hours
When are vitals taken when adminstering IV fluid
VS and chest auscultaiton taken prior to and following each fluid bolus
Contact MD if eterioration in clinical status
IV Fluid and sepsis
Ensure at least #20 gauge IV access is in place (large bore allowing fluid to flow quick)
Start IV Bolus (30mL/kg of IV crystalloid w/in 3h)
May insert a second IV access as necessary
Monitering a pt while intervening in sepsis
VS including O2 sat Qhx6h, then Q4hx12h
GCS Q1h x6h
Mointer urine output if able (May insert foley catheter as necessary)
Call MD if any deterioriation of vs or u/o <25cc/hr (Non-dialysis pts)
Endorgan
Kidneys
When monitering septic pts, what vs require contacting MD
RR<10>30
O2 sat<90%
P<40 or >140
Sys BP<90mmHg
Sudden change in LOC
Vasopressors and Inotropes
Norepinephrine
For pts with consistent HTON despite having recieved fluid
Required to be given in combo with Fluids
Need to be given via Central Vein OR large bore IV
Can be given for up to 6hrs
Moniter urine output bc blood flow will be reduced to kidneys
Other supportive treatments for septic pts
Minimize risk of HAIs (nosocomial)
Source control (Once source is identified, interventions to control this source must be implemented)
Aggressive Pulmonary management
- Ensuring pts are supported through deep breathing and coughing, early ambulation, transferring, etc.
Reducing O2 Demand, increasing O2 Delivering
Providing optimal nutrition and hydration as well as comfort
Tight glycemic control
MODS
Multiple organ dysfunction syndrome
What is MODS
A fine line bw septic shock and MODS
Characterized by the agreessive physioilogical dysfunction of two or more organs induced by things including sepsis
Mortality increases as organ failure increases
The eventual result of untreated septic shock
S/S of MODS in pts
Crackles in lungs (full of fluid)
Liver function test goes up
GI tract hypomobile (N/V)
Skin easily bruised
Kidneys decrease urine production and dark urine (BUN and creatine up)
Brain decreased LOC
Decreased HR near end
MODS treatment
Maintaitning adequate tissue oxygenation
Best strat to prevent MODS is preventing sepsis
What happens to spesis survivors
Genreally lower QOL
61% pts who survive severe sepsis live past 5 years
What kinds of antibiotics are given in SEPSIS?
As specific as possible
What is a lab
A type of test, generally for blood
Sources of infection for Sepsis
Neuro, respm GI, GU, Integ
What type of fluids are given as a sepsis intervention
IVF: Bolus 1-2 L
Be careful/cautious if Pt has renal failure or HF
What does the intervention of monitering include
VS/LOC/Urine output
urine output is important for kidney perfusion, therefore, if kidneys are being perfused the brain, heart and lungs are ALSO being perfused
Normal urine output
25-30mLs
True septic shock is
After intervention for sepsis has been given WITHOUT a response, shock is present
What are the SIRS Criterea
HR > 90bpm
Temo >38 <36
RR >20
Altered LOC (GCS)
WBC < 4 or > 12
In a sepsis pt, is a high temp or low temp more concerning?
Lowere than 36 - sign that the body is becoming hypothermic and no longer fighting infectoin
Sepsis =
SIRS criteria (2 or more) + Source of infecetion
Everyone with Sepsis has SIRS, but not everyone with SIRS has sepsis T or F
Correct
Sepsis USUALLY is once the bacteria has entered the bloodstream
If Sepsis interventions don’t work it results in
Septic Shock
Septic shock defind as
HOTN + SBP < 90 mmHG
MAP < 65 mmHG
Calculation for MAP
DBP x2 + SBP divided by 3
MODs
Altred funciton in 2 or more organs
4 Interventions for Sepsis
Labs and Diagnositics
