Back to FlashcardsMedicine / Pharm Y2S2 - Sepsis
Define sepsis
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Key Terms
Term
Definition
Define sepsis
an infection with systemic effects Such as: pyrexia, pallor, tachycardia and raised infection markers in the blood
Define severe sepsis
low urine output <0.5mL/Kg/hr low arterial oxygen concentrations changes in blood clotting (INR >1.5) raised bilirubin >70µmol/L raised lactate >1mmol...
Define septic shock
sepsis induced hypertension persisting despite fluid resuscitation. Systolic BP <90mmHg OR Mean arterial pressure 70mmHg
What are the risk factors for sepsis?
immunosuppression neonates & infants chronic disease recent surgery invasive procedures (e.g. catheters)
What is septic shock?
A deregulated inflammatory response involved the release of cytokines, nitric oxide, activation of complement and endothelial activation
What does vasodilation cause?
A reduction in systemic vascular resistance. Body becomes fluid deplete, perfusion of tissue is reduced, lactate and tissue ischaemia increase
Related Flashcard Decks
| Term | Definition |
|---|---|
Define sepsis | an infection with systemic effects Such as: pyrexia, pallor, tachycardia and raised infection markers in the blood |
Define severe sepsis | low urine output <0.5mL/Kg/hr low arterial oxygen concentrations changes in blood clotting (INR >1.5) raised bilirubin >70µmol/L raised lactate >1mmol/L |
Define septic shock | sepsis induced hypertension persisting despite fluid resuscitation. Systolic BP <90mmHg OR Mean arterial pressure 70mmHg |
What are the risk factors for sepsis? | immunosuppression neonates & infants chronic disease recent surgery invasive procedures (e.g. catheters) |
What is septic shock? | A deregulated inflammatory response involved the release of cytokines, nitric oxide, activation of complement and endothelial activation |
What does vasodilation cause? | A reduction in systemic vascular resistance. Body becomes fluid deplete, perfusion of tissue is reduced, lactate and tissue ischaemia increase |
Why is the first hour key to the outcome of patients with sepsis? | mortality increases by 10% for every hour delayed |
What is a rise in lactate a sign of? | Organ failure |
What are the ‘Sepsis Six’? | Administer O2 Take blood cultures Give broad spectrum antibiotics Fluid resuscitation Measure lactate Measure urine output |
What does administering O2 do and how is it given? | increases blood oxygenation and increases blood delivery to organs. - given through a face mask with 100% oxygen |
What are the indicators for needing to administer O2? | Raised lactate and low venous oxygen |
Why is it necessary to take blood cultures? | To identify the causative organism so that the correct treatment can be given. Treatment with antibiotics should be continued even when waiting for blood results. |
What are the likely organisms to cause a respiratory infection? | Gram positive - staph and strep |
What are the likely organisms to cause an abdominal infection? | Gram positive / negative anaerobes - E.coli or Klebsiella |
What are the likely organisms to cause a neutropenia infection? | Gram positive / negative organisms - Pseudomonas |
What are the indicators of infections? | Inflammatory markers - CRP and temperature Infection markers - WCC |
What kind of antibiotic cover should be given at first? | Both gram negative and positive 3rd gen cephalosporins e.g. cetriaxone macrolides e.g. clarithromycin |
What should be given for a neutropenia infection at first? | Broad spectrum penicillin (e.g. Piperacillin) which gives greater pseudomonas cover Aminoglycosides for gram negative |
What should be given for an acute abdomen infection? | Metronidazole |
What should should be given for staphylococci infections? | Flucloxacillin Rifampicin Vancomycin |
What should should be given for coliform infection? | Co-amoxiclav (pen sensitive) - Carbapenem (pen resistant) |
What should should be given for pseudomonas infection? | Ceftazidime (pen sensitive) |
What is the purpose of fluid resuscitation? | To help blood deliver O2 to tissue - restores circulating volume fluid volume and improves tissue perfusion |
What are the indicators for fluid resuscitation? | increased lactate decreased O2 saturation decreased urine output low blood pressure |
What is the treatment for fluid resuscitation? | 0.9% NaCl |
When is blood or plasma used for fluid resuscitation? | If Hb drops below 7g/L |
Why isn't creatinine a good marker of tissue perfusion? | Takes 3 days to show kidney injury |
What is lactate a marker of? | anaerobic respiration |
What should be done within 3 hours of a patient presenting with sepsis? | measure lactate obtain blood cultures broad spec antibiotic 30ml/kg crystalloid or >4mmol/L lactate |
What are the symptoms of septicaemia? | fever vomiting limb / joint / muscle pain cold hands and feet pale or mottled skin breathing fast rash sleepy confusion / delirium |