What is SIRS?
Systemic Inflammatory Response Syndrome
An inflammatory response to infection or a non-infectious insult that affects the whole body.
What is severe sepsis?
When the body's response to infection causes injury to its own tissues.
Severe sepsis = organ dysfunction
SIRS + infection = sepsis
What is septic shock?
Sepsis + hypotension despite fluid resuscitation + perfusion abnormalities e.g. lactic acidosis, reduced UO and GCS
Describe the pathogenesis of sepsis
Begins with stimulation of the innate/adaptive immune systems, which leads to the release of pro-inflammatory cytokines.
- = fever symptoms, vasodilation, increased capillary permeability, increased WCC and activity, decreased myocardial function. If severe, can lead to:
- Hypovolaemia, hypoxia and hypotension →
- Hypoperfusion of tissues →
- Anaerobic respiration and acidosis →
- End organ damage and multi-organ failure.
Which clinical features define SIRS?
> 1 of:
- Temp <36 or >38
- HR >90bpm
- Resps >20 or pCO2 < 32
- WCC high or low
- CBG > 7.7mmol/L unless DM present
Which red flag symptoms could indicate severe sepsis?
- Hypotension (<90mmHg systolic)
- HR >130bpm
- RR >25/min
- O2 sats <91%
- Reduced GCS
- Lactate >2mmol/L
- Purpuric rash
What indicators on the QSOFA score indicate sepsis?
Reduced conscious level
Systolic BP <100mmHg
Which infections could lead to severe sepsis?
- CNS: meningitis, encephalitis
- Infective endocarditis
- Infective gastroenteritis
- UTI (esp. pyelonephritis)
- SSTI (cellulitis and necrotising fasciitis)
- Osteomyelitis and septic arthritis
Describe the Sepsis 6
High flow Oxygen
What tool should be used to screen for sepsis?
Trust sepsis pathway