1. Pneumonia and Sepsis By Oliver Putt and Priyanca Patel For WMS Peer Support – 11 th November 2014

2. SIRS Systemic Inflammatory Response Syndrome It is not a diagnosis but the body’s response to an unknown pathogenic process Your patient is not feeling well

3. How to identify SIRS? The patient must have two or more of:

4. How to identify SIRS Temperature >38 o C or <36 o C

5. How to identify SIRS Heart rate: >90BPM

6. How to identify SIRS Respiratory rate >20 min -1 or pCO 2 <32mmHg

7. How to identify SIRS White cell count <4x10 9 /dl or >12x10 9 /dl

8. How do you identify SIRS?

9. How to identify SIRS

13. Sepsis SIRS with a known (or suspected) infection You patient is not feeling well and you know why

14. Severe Sepsis Sepsis with organ dysfunction You patient is not feeling well, you know why and now their body is struggling to cope

15. Septic Shock Sepsis with hypotension SBP <90mmHg

16. Septic Shock Despite fluid resuscitation

17. Septic Shock With perfusion abnormalities

18. Septic Shock Septic shock = sepsis + hypotension + perfusion abnormalities

19. The Sepsis Six Within 1 hour of suspecting sepsis you must implement the sepsis six care bundle Take 3 Give 3

20. Take 3 1. Blood cultures (Before antibiotics)

21. Take 3 2. FBC and serum lactate

22. Take 3 3. Start urine output measurements

23. Give 3 1. High flow oxygen

24. Give 3 2. Empirical IV antibiotics

25. Give 3 3. Fluid resuscitation

26. Sepsis Six

27. Summary

28. Pneumonia Infection and inflammation of the alveoli

29. Pathogens of pneumonia Community acquired: Influenza virus Streptococcus pneumoniae Hospital acquired: Staphylococcus aureus

30. Symptoms of pneumonia Dysponea Cough Sputum production Pleurisy

31. Signs of pneumonia Fever Tachypnoea Crackles Bronchial breath sounds

32. Investigations for pneumonia Peak expiratory flow rate (PEFR) Full blood count (FBC) Urea & electrolytes (U&Es) C-reactive protein (CRP) Lactate Arterial blood gases (ABGs) Chest radiograph (CXR) Nose & throat swabs : for viral investigations (PCR tests) Sputum

33. Treatment of pneumonia Community acquired: Amoxicillin Clarithomycin Hospital acquired: Piperacillin - tazobactam

34. When would you admit a patient with community acquired pneumonia?

35. CURB - 65 Confusion Urea >7mmol/l Respiratory rate >30/min Blood pressure <90mmHg (systolic) <60mmHg (diastolic) 65 years or older

36. CURB-65 – The Results >1 Admit >2 IV treatment