17860811
Description
Flashcards by Bryony Williams, updated more than 1 year ago
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Created by Bryony Williams
almost 5 years ago
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| Question | Answer |
| What is the definition of sepsis? | - Life-threatening organ dysfunction caused by dysregulated host response to infection |
| What is the definition of septic shock? | - Subset with circulatory + cellular/metabolic dysfunction associated with increased risk of mortality |
| When was sepsis first identified? | - In 1847 by Semmelweiss - Dr's were conducting post-mortems then attending women without washing hands - Handwashing introduced => infection rates decreased |
| What is Group A streptococcus? | - Beta-haemolytic streptococcus - Commonest cause of colds in small children - Causing maternal deaths - rapid deterioration - Handwashing before AND after toilet encouraged |
| What are the 4 systemic inflammatory response syndrome (SIRS) criteria? | 1) New onset confusion/altered mental state (reduced O2 to brain) 2) Heart rate >90bpm (reduced O2) 3) Body temp. <36 or >38 (kill virus/vasodilation 4) Hyperventilation >20/min or PaCO2 >32mmHg (increased O2 requirements) |
| What are the Quick-Sequential Organ Failure Assessment (q-SOFA) criteria? | 1) Mental status change 2) Systolic BP <100mmHg 3) Resp. rate >22/min [Score of 2-3 = high risk] |
| What are the Red Flag sepsis criteria? (Only 1 needed to trigger Sepsis 6) | - Systolic BP <90mmHg/40mmHg fall - HR >130bpm - O2 <91% - RR >25/min - Voice/pain response - Lactate >2.0mmol/L - No urine in last 18 hrs/>0.5ml/kg/hr - Confusion state - Non-blanching rash, ashen, cyanotic |
| What is the first stage in the development of sepsis? | - Patient initially injured in some way (not always visible) - Presence of pathogens in bloodstream elicits inflammatory response - Intricate link between inflammation + coagulation |
| How do tissue injury + pathogens affect the body? | - Causes stimulation of monocytes (leaders of immune system within tissues) - Produces cytokines, interleukin-1, IL-6 + TNF |
| What effects do cytokines have? | - Modulate release + activation of series of different agents - => IL-8, complement, histamine, kinins, serotonin, selectins, eicosanoids + neutrophils |
| What is the result of these different agents? | - Local vasodilation (further increased by inducible nitric oxide) - Release of cytotoxic chemicals = destruction of invading pathogens => RESPONSE TOO EXTREME IN SOME |
| What does this lead to? | - Process occurs in vasculature - Capillary lining is damaged (endothelium) |
| What is the endothelium? | - Not a passive surface - potent endocrine organ - Widely involved in maintenance of circulating volume + coagulation/fibrinolysis |
| What 3 major sequelae occur? | 1) Coagulopathy develops - intravascular thrombosis - tissue factor suppresses fibrinogen 2) Hypotension due to local metabolites + release of pathological nitric oxide 3) Widespread endothelial destruction - protein out => oedema |
| What are the 3 consequences of a loss of homeostasis? | 1) Increased coagulation 2) Increased inflammation 3) Decreased fibrinolysis |
| What 3 further injuries are the patient at risk of? | 1) Persistent inflammatory response 2) May develop secondary infection (e.g. nosocomial pneumonia) 3) May develop bacterial translocation from gut => ALL WILL INCREASE INFLAMMATORY RESPONSE |
| What 4 consequences occur if patient unable to compensate? | 1) Multi-organ dysfunction syndrome (MODS) 2) Require critical care 3) Often require mechanical ventilation 4) Cardiovascular support (e.g. inotrope to increase contractility) |
| What are risk factors for sepsis? | - Obesity - Impaired GT/diabetes - Impaired immunity - Anaemia - Vaginal discharge - H/O pelvic infection - H/O strep. B |
| Further risk factors for sepsis? | - Amniocentesis - Cervical cerclage - Prolonged SROM - Vaginal trauma - C/S - Wound haematoma - Retained products post-miscarriage/birth |
| Why is obesity a risk factor for sepsis? | - Increased adiposity - Adipose tissue poorly perfused |
| What are 6 common symptoms of sepsis? | 1) Fever 2) Diarrhoea 3) Vomiting 4) Abdo. pain 5) Rash 6) Vaginal discharge |
| What are 5 common clinical signs of sepsis? | 1) Tachycardia 2) Tachypnoea 3) Pyrexia 4) Elevated WCC 5) Elevated CRP |
| What are 2 hallmarks of septic shock? | - Persistent hypotension requiring vasopressors to maintain MAP >65mmHg (perfuse organs) - Serum lactate >2.0mmol depsite fluid resuscitation |
| What is the hospital mortality rate for septic shock? | - 40% |
| What are the "3-in" steps of Sepsis 6 pathway? | 1) 100% O2 through non-rebreathe mask (may require humidification) 2) Start IV fluids (do not exceed 30ml/kg/hr) 3) Commence IV antibiotics (broad spectrum - for every 1hr delay, mortality increases by 7.6%) |
| What are the "3-out" steps of Sepsis 6 pathway? | 4) Take blood cultures (BEFORE ABX) seek results after 48 hrs + Hb, CRP, U+Es, LFTs 5) Take serum lactate (>2.0mmol = sepsis, >4.0mmol = septic shock) 6) Insert IDC, send MSU - fluid balance with urometer => ALL WITHIN "GOLDEN" HOUR |
| What are features of septic shock? | - Tachycardia >90bpm - Tachypnoea >20/min - Pyrexia >38 degrees - Hypothermia <35 degrees - Hypotension (systolic <90mmHg) - Hypoxaemia - Poor peripheral perfusion - Oliguria |
| Further features of septic shock? | - Metabolic acidosis - Elevated lactate - +ve blood cultures - Abnormal coagulation - Abnormal liver/renal function tests |
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