Session 3: Acute Sepsis Flashcards
Define sepsis.
Characterised by a life-threatening organ dysfunction due to a dysregulated host response to infection. (This definition changes constantly)
Define septic shock.
A subset of sepsis where particularly profound circulatory, cellular and metabolic abnormalities substantially increase mortality.
What is sepsis?
Characterised by inflammation
Collection of physiological responses to an infection
Reactions of the immune system to infection becomes dysregulated (out of control)
Give clinical signs of local infection.
- Rubor
- Tumor
- Calor
- Dolor
What are the effects of sepsis on organ systems? (Think ABCDE)
Airways: No effect unless infection arises from throat or neck
Breathing: Raised respiratory rate (tachypnoea) + fluids and proteins leaking into interstitial tissues lead to lung oedema and decreased lung compliance.
Circulation: Hypovolaemia due to vasodilation and capillary leakage -> hypotension. Tachycardia
Disability: Reduced blood flow to brain, symptoms will follow
Exposure: High temp from hypothalamic response. Can also cause hypothermia
Who are especially at risk of sepsis?
<1 yrs
>75 yrs
Pregnant and post part
Impaired immune system
How is sepsis diagnosed?
- Triggering early warning score (NEWS2) (Elevated score does not provide a diagnosis but it points to it or something else being critically wrong.
- Looks ill
- Any sign of infection
What are the six physiological measurements of NEWS2 (National Early Warning Score)?
- Resp. rate
- O2 sat
- Systolic blood pressure
- Pulse rate
- Level of consciousness or new confusion
- Temperature
Red flags of sepsis.
- Alert, voice, pain, unresponsive levels (AVPU)
- Acute confusion
- Resp rate >25 per min
- O2 sat below 92%
- Heart rate > 130 bpm
- Systolic bp less than 90 mmHg (or drop of 40 below normal)
- No passing of urine for the last 18 hrs
- Non-blanching rash, mottled/ashen/cyanotic
- Recent chemotherapy
How is sepsis managed?
There are six steps called ‘Sepsis 6’.
1: Give O2
2: Take cultures
3: Give antibiotics
4: Consider fluids
5: Take HB and lactate
6: Monitor urine output
What would be the supportive investigations of suspected sepsis?
- FBC, Urea and electrolytes
- Blood sugar
- Liver function
- CRP
- Coagulation studies
- Blood gases
What would be the specific investigations of suspected sepsis?
- Cerebrospinal fluid
- Throat swab
- EDTA bottle for PCR
Explain the process of taking and handling cerebrospinal fluid.
- Lumbar puncture
- Urgent transport to lab
- Glucose and protein estimation in biochemistry, microscopy and culture in microbiology
- Appearance of it - turbidity and colour
- Microscopy of WBCs and RBCs
- Gram stain
- Referral for PCR
How is meningococcus transmitted?
Aerosols/droplets (airborne) and nasopharyngeal secretions
Explain the pathology of meningococcus (Neisseria meningitidis in this case).
Clearance, carriage or invasion of numerous serogroups based on the polysaccharide capsular antigen which evades immune response by preventing phagocytosis.
The outer membrane of the bacteria acts as an endotoxin.
