1

Question 1

what is sepsis?

Answer 1

evidence of infection plus organ dysfunction

serious complication of infection with high mortality

Question 2

what causes sepsis?

Answer 2

overwhelming host response to microorganisms causing damage to organs and tissues

Question 3

how is sepsis identified?

Answer 3

NEWS >5 + evidence of infection (cough, dysuria, abdo pain etc)

Question 4

3 levels of infection/sepsis?

Answer 4

infected (evidence of infection)
sepsis (evidence of organ dysfunction plus infection)
septic shock (hypotension despite fluid resuscitation and vasopressors, lactate >2)

Question 5

hartmans?

Answer 5

surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy

Question 6

BUFALO / give 3 and take 3?

Answer 6

Blood cultures (measure)
Urine output (measure)
Fluids (give)
Antibiotics (give)
Lactate (measure)
Oxygen (give)

Question 7

oxygen therapy?

Answer 7

measure sats
target 94-98%
if concerned, measure ABGs (gives info about resp and metabolic state as well as any potential COPD etc)

Question 8

blood cultures?

Answer 8

ALL CULTURES (sputum, from abscess etc)
consider other sources of sepsis (abscess, skin/soft tissue)

Question 9

antibiotic therapy?

Answer 9

ASAP (preferably within 1st hour)
try and localise source of infection to a system to guide antibiotic therapy (e.g if pneumonia related - co-amoxiclav etc)

Question 10

IV fluid therapy?

Answer 10

set volume over time (fluid challenge)
250-500mls over 15 mins (crystalloid - 0.9% saline or hartmanns)
aim for MAP of >65 mmhg
aim for 30 ml/kg over first 3 hours
if lack of response in BP then consider early transfer to MHDU for CVC +/- vasopressors

Question 11

why are fluids required in sepsis?

Answer 11

sepsis causes cardiovascular system to become very vasodilated causing hypotension

Question 12

lactate measurement?

Answer 12

high lactate = sign of hypoperfusion (low BP)
high lactate = high mortality
if >4, then should be repeated every 4-6 hours

Question 13

urine output?

Answer 13

marker of perfusion
fluid balance should be commenced on admission
may require catheter insertion
aim for 0.5ml/kg per hour

Question 14

when should buffalo be completed ?

Answer 14

within first hour

Question 15

what happens in hours 2-6?

Answer 15

continue resuscitation
- aim 30ml/kg in first 3 hours
- MAP > 65
- urine output >0.5ml/kg/hr
aim for 
- improvement in NEWS
- improve haemodynamic instability
- reduce lactate

Question 16

what is septic shock?

Answer 16

sepsis + hypotension and lactate >2 despite resuscitation

Question 17

concerning signs of deteriorating patient?

Answer 17

deteriorating NEWS
NEWS no responding to treatment
new confusion
high RR
low BP
low BM (blood sugar)

Question 18

QSOFA?

Answer 18

bedside criteria for deteriorating patient

• quick
• sepsis related
• organ
• failure
• assessment

Question 19

what QSOFA score has mortality of 40%?

Answer 19

> 2

Question 20

3 categories of NEWS?

Answer 20

1-4 = low = nurse assessment within ...
5-6 = medium = hourly review, medical review in 30 mins
7+ = high = 15 min observations, senior review within 15 mins

Question 21

non-responding patients?

Answer 21

escalate to MHDU
make a decision (i.e ceiling of treatment, is it worth it for age etc)
if MAP remains <65mmHg then add vasopressors via CVC
if noradrenaline escalating then
- ensure source control
- consider addition of steroid
- refer to ICU for addition of vasopressin

Question 22

first line vasopressor?

Answer 22

noradrenaline

Question 23

are steroids used in sepsis?

Answer 23

generally no

only in severe cases

Question 24

how does sepsis present?

Answer 24

SEPSIS

• Shivering, fever or very cold
• Excruciating pain or discomfort
• Pale or discoloured skin
• Sleepy, difficult to rouse, confused
• “I feel like I might die”
• Short of breath