Sepsis

Systemic Inflammatory Response Syndrome (SIRS) - 2 or more of:

• T > 38 or < 36

• HR > 90

• RR > 20

• WCC > 12 or < 4

Sepsis - SIRS + evidence of organ dysfunction (confusion, hypoxia, oliguria, metabolic acidosis)

Shock - Sepsis + haemodynamic instability (sys < 90) + raised lactate

Pathophysiology

The pathogens activate WBCs to release lots of cytokines, leading to vasodilation and increased vessel permeability → Systemic inflammation.

This widespread inflammation leads to oedema, which reduces the amount of oxygen reaching tissues.

Activation of the coagulation system leads to systemic fibrin deposition, which further reduces tissue perfusion - This also means that there’s increased consumption of platelets and clotting factors, therefore eventually leading to Thrombocytopenia and Bleeding → DIC (can be fatal).

Lactate (Type A) in increased due to inadquate oxgen delivery, therefore important to test for when sepsis is suspected.

N.B. Lactate Type B is the other type of lactate, that isn't rasied by inadquate oxgen delivery. The causes of it being raised includes metformin, genetics etc.

Presentation

• Fever, sweats or chills

• Breathlessness/SOB

• Headache

• N+V

• Diarrhoea

• O/E:

  • Hypotension

  • Tachycardia

  • Fever

  • Warm peripheries

  • Fast CRT

Management

• A-E assessment

• Sepsis 6:

  • Take blood cultures

  • Take lactate

  • Take urine output

  • Give O2

  • Give Abx

  • Give Fluids

N.B. Other investigations will need to be done depending on the potential source, such as CXR for chest infection, Urinalysis for UTI, or Echo for IE.