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- Y6 Critical Care and Palliative Care > *Sepsis syndromes > Flashcards

*Sepsis syndromes Flashcards

1
Q

What scoring system is used for Sepsis?

A

SOFA - sequential organ failure assessment score

and qSOFA (quick SOFA)

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2
Q

What are the components of qSOFA?

A
  • GCS <15
  • RR _>_22
  • Systolic _<_100

0-1 low risk

2-3 - high risk of hospital mortality (up to x14)

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3
Q

Risk factors for sepsis?

A
  • Chemo
  • Immunocompromise
  • Diabetes
  • Frailty
  • Comorbidities with end stage organ failure
  • Invasive or artificial devices
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4
Q

What is Sepsis 6?

A

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
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5
Q

What are the clinical features of sepsis?

A
  • 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
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6
Q

Give an example treatment for sepsis (non-penicillin allergic).

A

Ceftriaxone 2g IV OD + amikacin IV (max 48hrs)

+ metronidazole 500mg TDS IV (if likely abdo source)

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7
Q

How is lactate measured?

A

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’.

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8
Q

Define septicaemia.

A

= multiplication of bacteria in the bloodstream

Bacteraemia = presence of bacteria in the bloodstream

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9
Q

What is this rash and some causes?

A

Livedo reticularis

Normal in babies and children

Sepsis and DIC

Antiphospholipid syndrome

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10
Q

Define sepsis.

A
  • 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.

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11
Q

What is lactate an indicator of in sepsis?

A

Mortality

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12
Q

Name 3 biomarkers for sepsis.

A

CRP

WCC

Procalcitonin

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13
Q

What is Waterhouse-Friderichen syndrome?

A

Adrenal insufficiency (no mineralocorticoids or glucocorticoids) due to sepsis

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14
Q

What qSOFA score is indicative of increased mortality and organ dysfunction?

A

2 or more = sepsis

This diagnosis means 10% risk of mortality.

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15
Q

How is the MAP calculated?

A

MAP = CO x SVR

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16
Q

Name some types of central lines and their sites of insertion.

A

Types: single lumen, multilumen, wide bore

Sites: right internal jugular, left internal jugular, subclavian, femoral

17
Q

What are some complications of central lines?

A

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
18
Q

What are the indications for intubation?

A
  • Compromised airway/breathing
  • Hypoxaemia (and high FiO2)
  • GCS <8
  • Hypoventilation and PaCO2 >6kPa
  • Hyperventilation and PaCO2 <3.5kPa
19
Q

How is risk of mortality in sepsis calculated in ICU?

A

Increasing SOFA score indicates increased mortality.

20
Q

What does SIRS stand for and how is it related to sepsis?

A

SIRS = systemic inflammatory response score

SIRS + infection = sepsis

21
Q

Name a vasopressor and a inotrope.

A

Vasopressors = noradrenaline, dopamine - used for hypotension not responsive to fluids.

Inotropes = dobutamine - used for tissue hypoperfusion despite adequate fluid resuscitation.

22
Q

What are the targets of different observations in ICU?

A
  • 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
23
Q

What is the effect of delaying antibiotics in sepsis?

A

7% increase in mortality with every hour

24
Q

Name a cause of:

  1. CAP
  2. HAP
  3. Catheter related BSI
  4. Urosepsis
  5. GI source infections
A

CAP = S pneumoniae

HAP = H. influenzae

Catheter-related BSI = CNS, S aureus

Urosepsis = E coli, Proteus

GI sources = C diff

25
Q

What is the management of sepsis in ICU?

A
  • Tight glucose control
  • Steroids
  • Activated protein C - expensive
  • Lung protective ventilation
26
Q

What is the management of sepsis in ICU?

A
  • Tight glucose control
  • Steroids
  • Activated protein C - expensive
  • Lung protective ventilation
27
Q

What are some red flag features of sepsis (SASH MicroGuide)?

A
  • Systolic BP <90 or dropped by 40
  • HR >130
  • RR >25
  • O2 requirement to keep sats >92%
  • Non-blanching rash, mottled
  • Anuria in 18hrs
  • UO <0.5ml/kg/hr
  • Lactate >2
  • Recent chemotherapy
28
Q

When should you reassess the patient once sepsis 6 has been initiated?

A

Within an hour

29
Q

What antibiotics may be used in sepsis? (SASH MicroGuide)

A

Co-amoxiclav 1.2g IV TDS

AND Gentamicin 5mg/kg stat

If MRSA: add teicoplanin 800mg IV stat

If aspiration: add metronidazole 400mg PO TDS or 500mg IV TDS

30
Q

What antibiotic is used in sepsis (in penicillin allergy)? (SASH MicroGuide)

A

If non-anaphylactic reaction:

  • Cefuroxime 1.5g IV TDS
  • AND Gentamicin 5mg/kg IV stat

If previous anaphylaxis:

  • Teicoplanin 800mg IV stat then 400mg IV OD
  • AND Ciprofloxacin 400mg IV BD
  • AND Gentamicin 5mg/kg IV stat
31
Q

What antibiotic is added in sepsis management if the patient:

  1. has aspirated ?
  2. is MRSA positive?
A

If MRSA: add teicoplanin 800mg IV stat

If aspiration: add metronidazole 400mg PO TDS or 500mg IV TDS

32
Q

When should antibiotic treatment be reviewed in sepsis?

A

Within 24hrs or if culture results are back

Discuss with microbiology as necessary

33
Q

What are the complications of sepsis?

A
  • Renal dysfunction
  • Hypotension
  • ARDS
  • Heart failure
  • Organ failure
  • Encephalopathy
  • DIC
  • Neurological sequelae e.g. hearing loss, polyneuropathy

- Y6 Critical Care and Palliative Care (25 decks)

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