Week 3 - Acute sepsis in the ED Flashcards
How is N.meningitidis spread?
-Respiratory secretions
Is N.meningitidis always harmful?
-No many people are harmlessly colonised in back of throat
What virulence factors does N.Meningitidis have?
- LPS endotoxin -> induces inflammation, vasodilation and shock
- Pili -> attchment
- Polysaccharide capsule -> Adherence and evasion of phagocytosis
What is the gram status of N.meningitidis?
-Gram negative diplococci
What are the life threatening complications of bacterial meningtitis?
- Irreversible hypotension
- Resp failure
- Acute kidney injury
- Raised ICP
Describe the clinical presentation of bacterial meningitis
Acute onset:
- N+V
- Photophobia
- Stiff neck and general muscle aches
- Pupuric rash (non-blanching)
- Confusion and irritability
- Headache
What is the first line of treatment for bacterial meningitis?
-Ceftriaxone and vancomycin
What are the criteria for systemic inflammatory response syndrome?
Must have 2 or more of the following
- HR>90
- Temp38
- Resp>20/min
- WBC12x10^9
What are the criteria for Sepsis?
-SIRS plus documented/presumed infection
What is septicaemia?
-Bacteraemia with clinical features
What is severe sepsis defined as?
-SIRS+organ dysfunction or hypoperfusion
What is Septic Shock defined as?
-Severe sepsis and persistantly low bp despite fluids
What happens to coagulation during sepsis?
- Cytokines released from WBC stimulate thrombin and coagulation as well as inhibiting fibrinolysis
- This cascade leads to microvascular thrombosis causing ischaemia and necrosis (Disemminated intravascular coagulation)
What is the sepsis six?
Tasks to be delivered in one hour
- Blood culture
- IV Fluid resusitation
- L -> Serum lactose
- Empirical antibiotics
- Urine output measurement
- High flow oxygen
Why is raised ICP a contraindication for lumbar puncture?
- Raised ICF could indicate coning through foramen magnum
- If perform a lumbar puncture you increase the likeliness of coning
