Overview of sepsis

• How does infection, sepsis and SIRS relate to eachother?

  Infection is always present in sepsis but can or cannot be present in SIRS. Sepsis can be related to SIRS
• What does SIRS stand for?

  Systemic inflammatory response syndrome
• What has the most severity/mortality?

  Least to most: Infection, sepsis then SIRS
• What are the non-specific signs and symptoms of infection?

  Temperature (hot and sweaty)

  Rigors

  Anorexia

  Fatigue

  Myalgia

  Arthralgia
• What are the signs and symptoms related to respiratory infection?

  Respiratory infection: Shortness of breath, cough, sputum
• What are the signs and symptoms related to urinary infections?

  Frequency, dysuria, flank pain
• What are the signs and symptoms related to skin infections?

  erythema, pain
• What are the signs and symptoms related to meningitis?

  Headache, neck stiffness
• What are the signs and symptoms related to abdominal infection?

  pain, distension
• What does the SIRS stand for?

  systemic inflammatory response syndrome
• Clinical response to nonspecific insult is characterised by?

  Abnormal vital signs
• SIRS can be caused by?

  Infection +/- non infectious causes:

  Haemorrhage

  Infection

  Ischaemia

  Inflammation

  Trauma

  (HIIIT)
• How do you know there is systemic inflammatory response?

  Temperature <36C or >38.3C

  Heart rate >90 beats/min

  Respiratory rate >20 breaths/min

  Altered mental status

  WCC <4 x 10^9/L or >12 x 10^9/L

  Blood glucose >7.7 mmol/l in non-diabetic
• What is the normal range for blood glucose?

  4.0-7.0 mmol/l before meals
• What are the Rs in sepsis?

  Recognise, resuscitate, refer
• What is the irish national early warning system?

  Used to identify a deteriorating patient.

  Most countries have similar warning systems.

  A system NOT a score.
• What are the physiological observations in the document?

  Vital signs:

  Respiratory rate

  Oxygen saturation (+/- supplemental O2)

  Heart rate

  Blood pressure

  Level of consciousness

  Temperature
• What is sepsis?

  1. INFECTION

  2. Triggering a host response

  3. ORGAN DYSFUNCTION

  (Sepsis is a clinical diagnosis)
• At present, what are the interventions of sepsis?

  Resuscitation (sepsis 6)

  Referral (more senior review, critical care)
• 90% of cases with poor outcome in Australian sepsis database, what was found to be the most common feature?

  inadequate recognition
• What is hyperactivity of the immune response?

  Inflammation

  Coagulation

  Apoptosis
• What is a hyporeactive immune system?

  Anti-inflammatin

  Anti-coagulation

  Anti-apoptosis
• What happens when a pathogen enters ?

  Host response. Innate immune cells (macrophages) recognise and bind to microbial components.

  Series of steps that result in phagocytosis _ pathogen killing.
• What are the steps that result in phagocytosis and pathogen killing associated with?

  WIth the release of proinflammatory cytokines by macrophages, leading to the recruitment of additional inflammatory cells
• What is the innate immune response highly regulated by?

  A mixture of pro-inflammatory and anti-inflammatory mediators
• What is the proinflammatory cytokine response?

  SIRS response

  Simultaneous activation of coagulation and fibrinolysis

  Uncontrolled.unregulated intravascular inflammation
• Activation of the complement, coagulation and fibrinolytic systems may lead to?

  Microvascular thrombosis
• What are the systemic effects of sepsis?

  Widespread cellular injury = precursor to organ dysfunction.

  - Tissue ischaemia

  - Cytopathic injury

  - Altered rate of apoptosis

  - Immunosuppression
• What are some common sources of sepsis?

  Meningitis

  Skin or soft tissue infection

  Catheter related infection

  Urinary tract infection

  Pneumonia

  Blood stream infection

  Abdominal infections
• What are the most common infective sources of sepsis for adults in the ED and the ICU patients?

  1. Respiratory

  2. Urinary tract

  3. Intra-abdominal

  4. IV line BSI

  5. Devices

  6. CNS
• What are some risk factors for sepsis?

  Extremes of age

  Diabetes

  Immunosuppression

  - Disease induced

  - Medication induced
• What are some disease induced risk factors?

  Cancer, asplenism, HIV, renal failure, hepatic failure
• What are some medication induced risk factors?

  Chemotherapy, steroids, other immunosuppresive meds
• What is important about treatment of sepsis?

  Needs prompt treatment. Sepsis is a time-dependent medical emergency. Mortality increases by 7.6% for each hour delay to appropriate antibiotics
• What is Sepsis 6?

  Needs to be done in the 1st hour.

  Take 3: Blood cultures (before 1 dose antimicrobial), blood tests (incl POC lactate), urine output (perfusion status)

  Give 3: Oxygen (if required), IV fluids (if deficit), IV antibiotics (local guidelines)
• What are the principles of management?

  1. optimise organ perfusion (fluid resuscitation/vasopressors)

  2. Eradication infection

  3. Support dysfunctional organ systems
• How do we eradicate the infection?

  1. Identify source (the site of the infection causing sepsis)

  2. Source control (drainage of abscess, line/device removal)

  3. Antimicrobial therapy (consider likely source and causative organism and start smart)
• What are the general principles when choosing an antimicrobial?

  Clinical assessment

  Acquisition

  Previous antibiotics

  Previous microbiology results

  History of allergy