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12 Cards in this Set
- Front
- Back
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What is sepsis? |
Systemic inflammatory response to infection caused by microbial invasion of normally sterile parts of the body.
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What has to be present for sepsis to be diagnosed? |
Diagnosed when clinical suspicion/evidence of infection + evidence of systemic response, i.e. 2 or more of: - Temp >38% or <36 - HR >90/min - RR >20/min or pCO2 <4.3 - WBC >12 x 10^9/l or <4
Lab: FBC, clotting, CRP, lactate Micro: blood cultures x 2 before antibiotics, urine, samples from specific sites e.g. pus, CSF, joint aspirate, sputum |
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What is severe sepsis? |
Sepsis with organ dysfunction - Hypotension (systolic <90) - Lactic acidosis (due to poor perfusion) - Oliguria - Confusion - Liver dysfunction
Mortality 30-50% |
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What is septic shock? |
Severe sepsis with hypotension despite adequate fluid resuscitation
Mortality 50-60% |
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What is bacteraemia & septicaemia? |
Bacteraemia: presence of micro-organisms in bloodstream, may be transient (e.g. dental procedures), may be terminated by host immune system.
Septicaemia: bacteraemia + sepsis |
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What is the pathogenesis of sepsis? |
Immune cascade reaction
- Bacteria release endotoxins (G -ve) or extotoxins (G +ve) - Activation of macrophages - Release of inflammatory mediators e.g. TNF, interleukins - Endothelial activation and priming of neutrophils (immobilised in microcirculation) - Endothelial damage (extravasation of fluid with fall in blood volume & albumin, disseminated intravascular coagulation) - Poor tissue perfusion & poor lung function |
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What is infection endocarditis? What are some risk factors? |
Infection of the cardiac endothelium, typically involved heart valves. Certain organisms have a propensity to cause it e.g. staph aureus, enterococci, HACEK organisms
Risk factors: underlying valvular heart disease, IV drug use, indwelling central venous lines, prosthetic heart valves, implantable cardiac devises |
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How does infective endocarditis present? What is the treatment? |
May present non-specifically. Typical presentation is new murmur and febrile illness. - Complications e.g. embolic events - Classic signs e.g. Osler's nodes
Multiple blood cultures (x2) essential before antibiotics (IE causes continuous bacteraemia).
Treatment: high does IV antibiotics targeted against pathogen. Surgery (e.g. valve replacement) may be requires |
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How is sepsis managed? |
ABC, O2/fluid resuscitation, may need critical care input (ventilation, vasopressors). Monitor hourly urine output, antibiotic therapy to cover likely organisms, source control e.g. drain abscess |
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What is sepsis antibiotic therapy guided by? |
- Likely source e.g. biliary sepsis, likely Gram -ve bacillus - Previous microbiology e.g. MRSA colonisation - Local guidelines - Sensitivity results when available - Severity of presentation - Underlying disease and immunity |
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What are some risk factors for resistant organisms? |
- Previous isolation of the organism - Frequent hospital admissions - Prolonged stay on ICU - Hospital stay overseas - Nursing home resident (MRSA) - Previous antibiotic use e.g. recurrent UTIs, prophylactic antibiotics |
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What should be done in sepsis follow up? |
- Review to determine source - Potential for recurrence e.g. biliary sepsis - Consider endovascular focus/infective endocarditis (continuous bacteraemia esp gram +ve, positive blood cultures despite treatment, multiple sites of infection, signs of endocarditis) - Review CRP and ESR response - Monitor renal/liver failure |
