What is sepsis?
A life threatening organ dysfunction caused by dysregulated host response to infection
What is septic shock?
Characterised by persisting hypotension requiring vasopressors to maintain mean arterial pressure > 65 mmHg and having a serum lactate > 2 mmol/L despite adequate volume resuscitation
What are the symptoms of sepsis?
High RR High HR Feeling v hot/cold Chills/shivering Confused/disorientated Not passing much urine Weakness/aching muscles Skin rash/clammy, sweaty skin
What is the pathophysiology of sepsis?
- Pro inflammatory response
- Vasodilation and disturbances in micro circulation
- Mismatch O2 supply and demand
Mitochondrial dysfunction
Apoptosis - Tissue hypoxia
- Organ dysfunction
- Disseminated intravascular coagulation
What screening tools are there to assess for sepsis?
SIRS criteria
SOFA
NEWS2
NICE
What is the SIRS criteria?
Systemic inflammatory response syndrome If any 2 present: 1. Fever/hypothermia 2. HR > 90 bpm 3. RR > 20 bpm 4. WBC > 12 or <4 (x10^9/L) 5. BG > 7.7 mmol/L in non diabetics 6. New onset of confusion/drowsiness
What is SOFA assessment?
Sequential organ failure assessment
What is the NEW2 score?
Early warning signs of sepsis 6 parameters: 1. RR 2. O2 sat 3. Systolic BP 4. Pulse rate 5. Level of consciousness/new confusion 6. Temperature
What is the treatment for sepsis?
- Resuscitate (administer high flow O2)
- Identify source of infection (blood cultures)
- If bacterial - broad spectrum IV abx within 1 hour
- Switch to targeted abx once pathogen is confirmed
- IV Fluid resuscitation (colloids/crystalloids)
- Check repeat lactate after 2 hrs
- Check urine output hourly for 2 hrs
How to review treatment for sepsis?
Review IV abx every 24-48 hrs
Tailor to known pathogen
Switch to oral as soon as possible
Who requires a fluid challenge?
Hypotension patients / those with lactate > 4 mmol/L
What is the purpose of a fluid challenge?
Require IV to expand circulating fluid volume and restore perfusion pressure
What are the components of a fluid challenge?
- Type of fluid
- Administration rate
- Targets (mean AP > 65 mmHg, HR <110 bpm)
- Safety limit (development of pulmonary oedema)
What are supportive treatments for sepsis?
Vasopressors
Inotropic agents
What would you give if the pt still has a low mean arterial pressure despite adequate fluid resuscitation?
1st line = Norepinephrine
2nd line = Vasopressin
Not routinely = corticosteroids (in bacterial infection)
How to prevent sepsis?
- Vaccinations
- Good general hygiene
- PPE
- Abx stewardship
- Follow immunisation schedules for kids
