Severe infection and sepsis Flashcards
What is the definition of sepsis?
When the body’s response to infection causes injury to it’s own tissue or organs
What is Systemic Inflammatory Response Syndrome (SIRS)?
An inflammatory response to infection (or a non-infectious insult) that affects the whole body
Define severe sepsis
Sepsis with organ dysfunction
Define septic shock
Sepsis with hypotension (Systolic of <90mmHg) despite fluid resuscitation and perfusion abnormalities (e.g. lactic acidosis, decreased urine output or decreased GCS)
What is the Sepsis Six?
Care pathway for sepsis:
- High flow oxygen
- Blood cultures
- Empirical abx (IV)
- Measure FBC and serum lactate
- IV fluid resuscitation
- Accurate urine output measurements
Where would you find care pathways or guidelines for treating sepsis?
The BNF - medication advice
Local sepsis protocols - at trust level
Surviving Sepsis Campaign
What is the initial pathogenesis of symptoms?
Stimulation of immune response causes release of cytokines which leads to:
Fever symptoms Vasodilation Increased capillary permeability Increased white blood cell count Decreased myocardial function
What is the pathogenesis of the later stages of sepsis?
Hypovolemia (caused by leakage of blood and plasma into surrounding tissue)
Hypoxaemia (e.g. due to acute respiratory distress syndrome or pulmonary oedema which prevents oxygenation of blood) -> Lactic Acidosis
Hypotension (due to decreased myocardial contraction and prolonged vasodilation/ decreased vascular resistance)
Organ damage/ Multi-organ failure (due to hypoperfusion or organs)
What is the clinical criteria for diagnosing sepsis?
Infection + SOFA (must present with 2+ from criteria)
- Decreased PaO2
- Hypotension or Vasopressors
- Decreased platelets
- Decreased GCS
- Increased Bilirubin
- Increased Creatinine or Oliguria
What is the bedside criteria for diagnosing sepsis?
Q-SOFA
- Respiratory rate of 22 or above
- Altered cognition
- Systolic BP of equal to or less than 100mmHg
