Sepsis

• What is sepsis?


  Life-threatening organ dysfunction caused by dysregulated host response to infection
• What is septic shock?


  More severe form of sepsis. Circulatory, cellular, and metabolic abnormalities that are associated with a greater risk of mortality than sepsis alone
• What are the most common sources of infection in sepsis?

  Pneumonia

  Intra-abdominal infections

  UTIs

  Skin & soft tissue infections

  Bacteraemia (frequently from indwelling catheters or other medical devices)
• Pathophys of sepsis


  Complex interplay between infection pathogen & host's immune response

  Pathogens produce virulence factors → tissue damage → PAMPs → PRRs recognise → triggers intracellular signalling pathways & release of pro-inflam cytokines & chemokines (TNF-a, IL-1b, IL-6) → systemic response (vasodilation, increased vascular permeability & activate coagulation cascade) → tissue hypoperfusion, microvascular thrombosis → multiple organ dysfunction syndrome (MODS)
• Initial pro-inflammatory phase followed by compensatory anti-inflammatory response syndrome (CARS) → release anti-inflam cytokines (IL-10, TGF-b) & suppress immune system → immunosuppressive state
• What are the Inx for sepsis?


  Obs

  Full Hx & examination

  ECG

  Bloods (FBC, U&E, LFTs. CRP, glucose, coag, cultures, ABG/VBG)

  CXR

  CT

  Echo (investigate causes of haemodynamic instability)

  HIV screen

  Viral swabs (if suspect resp source of infection)

  Lumbar puncture (if suspect meningitis or encephalitis

  Urinalysis (if suspect urinary source of infection)
• What are the scoring tools used to help recognise sepsis?


  qSOFA

  SOFA

  NEWS2
• What is qSOFA?

  Quick Sequential Organ Failure Assessment

  Each domain scores 1 point

  • Resp rate > 22
  • Altered mental status (GCS < 15)
  • Systolic BP < 100 mmHg

  Positive score >/= 2

  -> heightened risk of mortality
• What is SOFA?


  Sequential Organ Failure Assessment

  Score >/= 2

  -> overall mortality risk of approx 10% in general hospital population with suspected infection

  Takes into account...

  • PaO2
  • Platelets
  • Bilirubin
  • Cardiovascular
  • GCS
  • Creatinine
  • Urine output
• What NEWS score should make you think about sepsis?


  5 or more
• What are the DDx of sepsis?


  Acute alcohol withdrawal

  Acute blood loss & hypovolaemia

  Acute delirium

  Acute MI

  Acute pancreatitis

  Diabetic ketoacidosis

  HF

  Intoxication & poisoning

  PE

  Thyrotoxicosis

  Trauma & tissue injury

  Drug reactions
• What are the RFs of sepsis?


  Extremes of ages (≤ 1 or ≥ 75)

  Immunosuppression

  Chronic disease (COPD, diabetes)

  Prior organ dysfunction

  Recent surgery/invasive procedure in the past 6 weeks

  Pregnancy/miscarriage in the past 6 weeks

  IV drug users

  Indwelling line or catheters
• What are the signs & symptoms of sepsis?


  NEWS score >/= 5

  Tachypnoea

  Changes in body temp

  Tachycardia

  Altered mental status (acutely)

  Low O2 sats

  Hypotension

  Oliguria

  Cyanosis

  Poor cap refill

  Non-blanching rash

  Syncope

  Signs associated with specific sites of infection
• What are the complications of sepsis?

  Death

  Organ dysfunction & failure

  Recurrent & secondary infection

  Coagulopathy

  Reduced QoL

  Neurological sequelae

  Cognitive & functional disability

  Psychological sequelae
• What is the treatment of sepsis?

  Sepsis 6 (BUFALO)

  Blood cultures (before giving IV Abx)

  Urine output (measure hourly)

  Fluids (IV)

  Abx (IV, broad spec)

  Lactate

  O2