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 reposnse 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 postive / 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 cephalosprins 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
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