Sepsis
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Definition
There are some issues with definition that need to be cleared up
- SIRS (systemic inflammatory response syndrome) - body's defensive response to an acute, serious systemic illness. Outlined in further details below as sepsis is a major cause.
- Sepsis - infection with SIRS
- Bacteraemia - presence of bacteria in blood
- Septicaemia - obsolete term (though still used instead of sepsis) which is an inaccurate combination of the above two.
- Septic shock - shock due to sepsis
Epidemiology
Pathophysiology
Whenever you get an infection, it's not great. However, when it enters your bloodstream, things tend to get markedly worse.
Risk Factors
Having an infection.
Clinical Features
Sepsis is due to infection so general symptoms of infection apply: fever, tiredness
Then, you need to look at SIRS which is where 2 of the following are present:
- Temperature >38oC/<36oC
- Tachycardia (>90bpm)
- Tachypnoea (RR>20b/min)/PaCO2<4.3kPa
- WBC>12x109/L or <4x109 or 10% immature 'band' forms
Management
Basically see hypovolaemic shock and do what you would do for them. Then add the appropriate antibiotics:
- Urinary tract sepsis - cefuroxime 1.5g/8h iv + gentamicin 5mg/kg od iv (rarely 7mg/kg)
- Intra-abdominal sepsis - cefuroxime 1.5g/8h iv + metronidazole 500mg/8h iv
- Meningococcal sepsis - ceftriaxone 2g/12h iv
- Neutropenic sepsis - Tazocin 4.5g/8h iv over 3-5min + netilmicin 6mg/kg od iv
- Unknown cause - cefuroxime 1.5g/8h + metronidazole 500mg/8h + gentamicin 5mg/kg od iv