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
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