2.5. Recognition and Management of Sepsis Flashcards
From a History, what is the Sepsis:
1. High Risk criteria?
2. Moderate Risk criteria?
3. Low Risk criteria?
- Objective evidence of new altered mental state
- a) History of new onset of altered mental state
- b) History of acute deterioration of functional ability
- c) Impaired immune system (illness or drugs)
- d) Trauma / Surgery / Invasive Procedure in the last 6 weeks
- Normal behaviour
From a Respiratory Examination, what is the Sepsis:
1. High Risk criteria?
2. Moderate Risk criteria?
3. Low Risk criteria?
- a) Raised Respiratory Rate (25 breaths/min)
- b) New need for O2 to maintain sats > 92%
- Raise Respiratory Rate (21-24 breaths/min)
- No High / Moderate Risk criteria met
From a Blood Pressure Examination, what is the Sepsis:
1. High Risk criteria?
2. Moderate Risk criteria?
3. Low Risk criteria?
- Systolic B.P. > 90mmHg (or 40mmHg below normal)
- Systolic B.P. 91-100mmHg
- No High / Moderate Risk criteria met
From a Circulation and Hydration Examination, what is the Sepsis:
1. High Risk criteria?
2. Moderate Risk criteria?
3. Low Risk criteria?
- a) Raised Heart Rate (> 130bpm)
- b) Not passed urine in the past 18hrs
- c) >0.5ml/kg/hr urine passed (catheterized patients)
- a) Raised Heart Rate (91-130bpm)
- b) Not passed urine in the passed 12-18hrs
- c) 0.5-1.0ml/kg/hr urine passed (catheterized patients)
- No High / Moderate Risk criteria met
From a Temperature Examination, what is the Sepsis:
1. High Risk criteria?
2. Moderate Risk criteria?
3. Low Risk criteria?
- N/A
- Tympanic temperature less than 36 degrees
- N/A
From a Skin Examination, what is the Sepsis:
1. High Risk criteria?
2. Moderate Risk criteria?
3. Low Risk criteria?
- a) Mottled or Ashen appearance
- b) Cyanosis of skin, lips or tongue
- c) Non-blanching rash of skin
- Signs of potential infection at a wound (Redness, swelling, discharge etc)
- a) No non-blanching rash
What are the management stages of a patient over the age of 12, with Sepsis?
- Patient with suspected Sepsis
- a) NICE pathway on acutely ill patients in hospital
- b) Information for patients (+ families) with Sepsis
(Follow on from 2. b) - Identify the source of infection
- Assess the Risk Criteria for the condition is (SOFA)
- Treat with the Sepsis 6
- Discharge information
What does the “Sepsis 6” include?
“You take 3”:
1. Blood Cultures
2. Blood Lactate
3. Measure urine output
“You give 3”:
4. Oxygen (aim O2 saturation bwteen 94-98%)
5. I.V. Antibiotics
6. I.V. Fluid Challenge
- Why are blood cultures taken (in the Sepsis 6)?
- When are they taken?
- To make a microbiological diagnosis (30-50% are positive)
- As soon as posible after onset of Fever / Chills
Note - if spike in temperature then take 2 sets
Why is blood lactate taken (in the Sepsis 6)?
It is a marker of generalised hypoperfusion / severe sepsis / poor prognosis
Why is urine output measured (in the Sepsis 6)?
It is a marker of Renal Dysfunction
How is the antibiotic prescribed worked out?
- Based on working diagnosis from History / Examination
- Local antibiotic guidlines
Note - remember most infections below the diaphragm are Gram Negative, and above are Gram Positive
What should be considered when prescribing antibiotics?
- Allergy
- Previous MRSA (Methicillin-Resistant Staphylococcus Aureus), ESBL (Extended Spectrum Beta Lactamases), CPE (Carbapenemase Producing Enterobacteriaceae)
- Antibiotics toxicity / interactions
How much I.V. Fluid Challenge is given to a person with Sepsis?
30ml/Kg (2.1L for a 70Kg patient)
Other than giving fluid, what is also done in the I.V. Fluid Challenge?
Stop any anti-hypertensive medication
Note - they’re not going to die instantly from hypertension but will from septic shock
