Sepsis

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  • Created by: Amh
  • Created on: 17-03-16 17:09
What is the normal flora of the blood stream
nothing, should be sterile
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What is bacteraemia
presence of bacteria in the blood
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does bacteraemia often happen
yes e.g. brushing teeth
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What happens if your blood is colonised by a a very virulent organism
You can become septic
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why is sepsis life threatening
it forces your immune system into over drive - causing a cytokine storm and death
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what are the symptoms of septicaemia
fever or hypothermia, hyperventillation, chills, shaking, warm skin, rash, rapid heart beat, confusion, low urine output
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What are the diagnostic indicators of septicaemia?
WBC count really high or really low, low platelet, positive blood culture, glood gases reveal acidosis, kidney tests normal
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Common sites of infections from sepsis
Kidneys, liver or gall bladder, bowel, skin, lungs, heart
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Why is sepsis more common in hospitalised patients
They may have things like IV lines, surgical wounds, surgical drains, bedsores, may already be immunosurpressed, and exposed to a whole new niche of bacteria
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How many blood cultuers do we need to confirm sepsis and how positive do they need
Need at least 3, and we need to be able to get growth from 90% of this
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What does normocytic/normochromic anaemia mean and why do septic patients have it
Low red blood cell count, because the bone marrow is exhausted
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What is the white blood cell count like
Varied could be raised because of an effective immune response being launched, or decreased because the wbc are being destroyed
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What will the WBC look like under the microscope?
May have a left shift - because they are being pushed out immaturely
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Patients would have thrombocytopenia, what is this?
low platlet count
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What is C reacive protein and why would it be elevated in sepsis
CRP is a biomarker is a substance produced in the liver in response to inflammation, high levels = an immunoresponse
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Why do we check the urine
Kidneys will be the first organ to fail, if creatinine levels are scrwed indicates kidneys arent working properly
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How do we take blood cultures
In bottles with bacteria medium blood goes into the bottles, we take x2 30mls of blood, one is aerobic one is anaerobic
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how do we treat sepsis
Broad spectrum antibiotics  Oxygen  Intravenous fluids  Medication to increase blood pressure  Dialysis for kidney failure
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Infective endocarditis
....
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what is infectie endocarditis
infection of heart endocardum
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what is a characterisitc IE
formation of vegetation in areas of trauma or turbulenece - valves
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What bacteria is likeley to cause acute IE
Staph aureus
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What bacteria is likeley to cause subacute IE
Viridans Streptococc
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What are the risk factors for IE
Transient bacteremia, and prexisiting cardiac lesion
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Give an example of transient bacteremia
Poor dental hygiene; dentistry Genito-urinary manipulation Line insertion; Intravenous drug use Surgery
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Give an example of prexisiting cardiac lesion
Rheumatic heart disease Congenital heart disease Degenerative heart disease (eg. MV prolapse)
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Which valve is most likeley to be involved
mitral, then aortic, then tricuspid then pulomonc
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What does right hand sided endocarditi look like
tricuspid regurg. murmur, R heart failure
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What are the clinical manifestations
Heart murmur/failure, fever weight loss, anaemia. Emboli in limbs,kidneys mesentery CNS, microscopic haematuria, splinter hemorrhages, conjunctival petechiae, Osler´s nodes, Janeway lesions, Roth´s spots
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where do splinter haemorrhages occur
finger nails
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where does oslers nodes appear
in feet and palms of hands
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where are roths spots
retina
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What complications can arise from IE
valvular destruction or assoc myocarditis. CNS emboli -stroke, brain abscess kidney emboli – focal GN, renal failure, renal infarction coronary artery emboli – angina, MI spleen emboli – splenic infarct. arrhythmias pericarditis, myocardial abscess
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why would you do an ECG
Will show incidende of complications related to size of vegetation
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Which eco should you use
a normal transthoracic echo (TTE) does not exclude endocarditis  more sensitive is transesophageal (TOE)
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What criteria is used for IE
Duke criteria
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what are the major diagnostic criteria
1. positive blood culture 2. A positive echocardiogram showing Endocardium involvement
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what are the minor criteria
Fever Predisposition Vascular / immunological phenomena Positive blood cultures, not meeting major criteria Positive echo that does not meet major criteria
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what do you need for an IE diagnsis
2M or 1M3m or 5m diagnostic
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what is the mortality of IE
37%
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Why is there a high mortality
high bacterial levels in vegetations  decerased susceptibility to Abx in vegetations
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how dp you treat ie
use bactericidal Abx, IV route, high dose ▪ synergistic combinations ▪ treat for at least 4 weeks to avoid relapse
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what is the empirical treatment for acute presentation
Acute presentation: ▪ Fluclox (2g iv 4-6hourly) + Gent (1mg/kg iv 8hourly)
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what is the empirical treatment for indolent presentation
Pen 1.2g iv 4-hourly (Amp/Amoxy 2g 6hourly) + Gent 1mg/kg tds
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what is the empirical treatment forPen allergy, MRSA or intra-cardiac prosthesis
Vanc 1g iv bd plus Rif 300-600mg po bd plus gent 1mg/kg tds
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When is surgery needed
A. Uncontrolled infection ▪ valve-ring abscess, aneurysm formation ▪ fungal infection  B. Occurrence of major emboli  C. Refractory or progressive CHF  D. Prosthetic valve endocarditis
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What is bacteraemia

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presence of bacteria in the blood

Card 3

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does bacteraemia often happen

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Card 4

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What happens if your blood is colonised by a a very virulent organism

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Card 5

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why is sepsis life threatening

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