SEPSIS + THE DETERIORATING PATIENT

Question 1

what is the sepsis pathway?

Answer 1

It is a document that guides health professionals to allow for early recognition and detection of sepsis.

Question 2

what are the resuscitative interventions for a septic patient (sepsis 6/ BUFALO)?

Answer 2

B = blood cultures, FBC, CRP, urine, swabs (infection screen

U = Urine screen

F = Fluids IV

A = Antibiotics

L = Lactate measurement

O = Oxygen

Question 3

what are we looking for when we take blood in a possible sepsis patient?

Answer 3

• blood cultures
• WC
• WBCC

Investigate the source of infection

Question 4

Why do we take a urine sample in a possible sepsis patient?

Answer 4

Sepsis can cause AKI

Question 5

Why do we administer fluids in a potential sepsis patient?

Answer 5

Fluid replacement combats hypotension

Question 6

Why do we administer antibiotics to possible sepsis patients?

Answer 6

Broad spectrum Abx until we know the cause of infection and can treat it specifically

Question 7

Why do we measure lactate levels in sepsis patients?

Answer 7

Elevated lactate levels may indicate lactic acidosis

Red flag if lactate is >2mmol
>4mmol is clinically significant

Do venous/arterial blood gasses to monitor blood pH

Question 8

why do we provide oxygen therapy for sepsis patients?

Answer 8

Aim sats 95%+

Use O2 in tachyponec patients

Observe for altered LOC

Question 9

Describe the pathophysiology of sepsis/sepsis process

Answer 9

Sepsis is a life-threatening response to infection. When sepsis develops chemicals are released by the immune system into the bloodstream, thus causing widespread systemic inflammation. There is a fluid movement across capillary walls which is dependent on hydrostatic pressure within the capillaries and osmotic pressure on the outside

Septic process: infection (inflammatory response to microorganisms), bacteraemia (viable bacteria in blood), systemic inflammatory response syndrome (increase/decrease temp, tachycardia and high RR).

2nd answer: Sepsis occurs when an infectious material (often a bacteria) enters the patient’s bloodstream (bacteraemia). An inflammatory response initially occurs at a localised infective site. WBC initiates the inflammatory cascade and releases nitric oxide that causes vasodilation. This increases capillary permeability which causes vessels to become leaky. As a result, there is fluid shift from the circulation into the interstitial tissue, causing edema → the patient may become mildly hypotensive with an elevated heart rate as compensation. An increase in capillary permeability and increased coagulation factors also impairs tissue oxygenation and increases the risk of blood clots → the patient may present with tachypnoea due to tissue hypoperfusion, hypoxia and febrile. It’s only when the bacteria reach the circulation that causes a widespread systemic inflammatory response (systemic inflammatory response syndrome/SIRS). The patient’s blood pressure will further drop below 60mmHg which puts them at risk of multi-organ failure.

Question 10

what are the most common sources of infection?

Answer 10

• respiratory
• post-op infection
• lungs
• catheter site
• device related
• central nervous system
• bacteremia
• abdominal
• endocarditis