Pneumonia and Sepsis

By Oliver Putt and Priyanca Patel

For WMS Peer Support – 11th November 2014

SIRSSystemic Inflammatory

Response Syndrome

It is not a diagnosis but the body’s response to an unknown pathogenic process

Your patient is not feeling well

How to identify SIRS?The patient

must have two or more of:

How to identify SIRSTemperature

>38oC or <36oC

How to identify SIRSHeart rate:

>90BPM

How to identify SIRSRespiratory

rate >20 min-1

or pCO2

<32mmHg

How to identify SIRSWhite cell

count <4x109/dl or >12x109/dl

How do you identify SIRS?

How to identify SIRS

How to identify SIRS

How to identify SIRS

How to identify SIRS

SepsisSIRS with a

known (or suspected) infection

You patient is not feeling well and you know why

Severe SepsisSepsis with

organ dysfunction

You patient is not feeling well, you know why and now their body is struggling to cope

Septic ShockSepsis with

hypotension

SBP <90mmHg

Septic ShockDespite fluid

resuscitation

Septic ShockWith

perfusion abnormalities

Septic Shock

Septic shock =

sepsis +

hypotension +

perfusion abnormalities

The Sepsis SixWithin 1 hour of

suspecting sepsis you must implement the sepsis six care bundle

Take 3

Give 3

Take 31.Blood

cultures (Before antibiotics)

Take 32.FBC and

serum lactate

Take 33. Start urine

output measurements

Give 31.High flow

oxygen

Give 32.Empirical IV

antibiotics

Give 33. Fluid

resuscitation

Sepsis Six

Summary

PneumoniaInfection and

inflammation of the alveoli

Pathogens of pneumoniaCommunity

acquired:Influenza virusStreptococcus

pneumoniae

Hospital acquired:Staphylococcus

aureus

Symptoms of pneumoniaDysponea

Cough

Sputum production

Pleurisy

Signs of pneumoniaFever

Tachypnoea

Crackles

Bronchial breath sounds

Investigations for pneumonia

Peak expiratory flow rate (PEFR)

Full blood count (FBC)

Urea & electrolytes (U&Es)

C-reactive protein (CRP)

LactateArterial blood gases

(ABGs)Chest radiograph

(CXR)Nose & throat

swabs : for viral investigations (PCR tests)

Sputum

Treatment of pneumoniaCommunity

acquired:AmoxicillinClarithomycin

Hospital acquired:Piperacillin -

tazobactam

When would you admit a patient with community acquired pneumonia?

CURB - 65Confusion

Urea >7mmol/l

Respiratory rate >30/min

Blood pressure<90mmHg

(systolic) <60mmHg

(diastolic)

65 years or older

CURB-65 – The Results>1 Admit

>2 IV treatment