*Sepsis syndromes Flashcards
What scoring system is used for Sepsis?
SOFA - sequential organ failure assessment score
and qSOFA (quick SOFA)
What are the components of qSOFA?
- GCS <15
- RR _>_22
- Systolic _<_100
0-1 low risk
2-3 - high risk of hospital mortality (up to x14)
Risk factors for sepsis?
- Chemo
- Immunocompromise
- Diabetes
- Frailty
- Comorbidities with end stage organ failure
- Invasive or artificial devices
What is Sepsis 6?
3 in, 3 out
- Lactate >4 –> resuscitate 30ml/kg
- Urine output - catheterise
- Blood cultures
- Abx - every hour delay leads to 8% increase in mortality
- Oxygen - aim >94%
- Fluids - if hypotensive or raised lactate; give in 30ml/kg in 500ml boluses, but consider less 250ml if elderl or known cardiac condition
What are the clinical features of sepsis?
- RR ≥20
- Fever >38 or <36
- HR >90
- Abnormal WCC >12 or <4
- New confusion
- New oxygen requirement (40% FiO2 +)
- Systolic ≤90mmHg or 40mmHg below usual
- Anuria/ low urine output
- Mottled, cyanosis or non-blanching skin rash
- NEWS _>_5
Give an example treatment for sepsis (non-penicillin allergic).
Ceftriaxone 2g IV OD + amikacin IV (max 48hrs)
+ metronidazole 500mg TDS IV (if likely abdo source)
How is lactate measured?
The fastest method of checking lactate is via a venous (or arterial) blood gas. A laboratory lactate level takes longer to process and the sample needs to be transported from patient to lab ‘on ice’.
Define septicaemia.
= multiplication of bacteria in the bloodstream
Bacteraemia = presence of bacteria in the bloodstream
What is this rash and some causes?
Livedo reticularis
Normal in babies and children
Sepsis and DIC
Antiphospholipid syndrome
Define sepsis.
- Life threatening organ dysfunction
- Due to infective organism
- Causing a dysregulated host response
Defined as qSOFA of 2 or more.
NB: SIRS criteria is no longer used as it was crude.
What is lactate an indicator of in sepsis?
Mortality
Name 3 biomarkers for sepsis.
CRP
WCC
Procalcitonin
What is Waterhouse-Friderichen syndrome?
Adrenal insufficiency (no mineralocorticoids or glucocorticoids) due to sepsis
What qSOFA score is indicative of increased mortality and organ dysfunction?
2 or more = sepsis
This diagnosis means 10% risk of mortality.
How is the MAP calculated?
MAP = CO x SVR
Name some types of central lines and their sites of insertion.
Types: single lumen, multilumen, wide bore
Sites: right internal jugular, left internal jugular, subclavian, femoral
What are some complications of central lines?
Early:
- Damage to veins/arteries/nerves
- Pneumothorax (esp with subclavian route)
- Arrhythmia
- Air embolism
- Puncture of great vessels or heart
Late:
- Infection
- Extravasation of irritant drugs
- Air embolism
- Bleeding
- Catheter breakage/knotting
- Penetration of vessel wall or heart
What are the indications for intubation?
- Compromised airway/breathing
- Hypoxaemia (and high FiO2)
- GCS <8
- Hypoventilation and PaCO2 >6kPa
- Hyperventilation and PaCO2 <3.5kPa
How is risk of mortality in sepsis calculated in ICU?
Increasing SOFA score indicates increased mortality.
What does SIRS stand for and how is it related to sepsis?
SIRS = systemic inflammatory response score
SIRS + infection = sepsis
Name a vasopressor and a inotrope.
Vasopressors = noradrenaline, dopamine - used for hypotension not responsive to fluids.
Inotropes = dobutamine - used for tissue hypoperfusion despite adequate fluid resuscitation.
What are the targets of different observations in ICU?
- CVP 8-12mmHg (or rise of 3-5 after fluids)
- MAP >65mmHg but <90mmHg
- UO 0.5ml/kg/hr
- Scv O2 saturation >70%
- Hct >0.3 (transfuse red cells if necessary)
- Glucose 8-10mmol/L is recommended
What is the effect of delaying antibiotics in sepsis?
7% increase in mortality with every hour
Name a cause of:
- CAP
- HAP
- Catheter related BSI
- Urosepsis
- GI source infections
CAP = S pneumoniae
HAP = H. influenzae
Catheter-related BSI = CNS, S aureus
Urosepsis = E coli, Proteus
GI sources = C diff
