Acute sepsis in the emergency department

Question 1

what is sepsis

Answer 1

life threatening organ dysfunction due to a dysregulated host response to infection
characterised by inflammation

Question 2

what is septic shock

Answer 2

subset of sepsis where particularly profound circulatory, cellular and metabolic abnormalities substantially increase mortality

Question 3

effects of sepsis on organ systems (abce)

Answer 3

A-airways . no specific effect unless infection arises from throat or neck
B-breathing. tachypnoea(raised respiratory rate). fluids and proteins leaking into interstitial tissues lead to lung oedema and decreased lung compliance.
C-circulation. hypovolaemia due to vasodilation and capillary leakage leading to hypotension. tachycardia and end organ damage
D-disability. reduced blood flow to the brain. presets as confusion, slurred speech, agitation, anxiety or decreased level of consciousness
E- exposure. high temp due to hypothalamic response to infection. hypothermia in elderly

Question 4

when should a patient seek urgent medical help (sepsis)

Answer 4

Slurred speech 
extreme shivering or muscle pain 
Passing no urine in a day 
severe breathlessness 
it feels like you're going to die 
skin mottled/ discoloured

Question 5

who is especially at risk of sepsis

Answer 5

very young <1 years old
elderly >75
pregnant / postpartum (within 6 weeks)
patients with impaired immune system due to illness or drugs

Question 6

what physiological measurements are covered in the national early warning score(NEWS2) and who is it valid to use on
at what score should you think sepsis

Answer 6

non-pregnant adults 
1. respiration rate 
2.oxygen saturation 
3. systolic blood pressure 
4. pulse rate 
5. level of consciousness or new confusion 
6. temp 
score of 5 or more think sepsis

Question 7

how is sepsis managed

Answer 7

sepsis 6

1. give oxygen
2. take cultures
3. give antibiotics
4. consider fluids
5. take Hb & lactate
6. monitor urine output

Question 8

what is a non-blanching rash

Answer 8

if you place a glass cup against it, it stays the same colour and doesn’t turn white

Question 9

name some specific and supportive investigations for sepsis

Answer 9

specific -cerebrospinal fluid , throat swab, EDTA bottle for PCR
supportive- FBC, urea, electrolytes, CRP, LFT, clotting

Question 10

how does sepsis affect the kidneys

Answer 10

as a result of reduced blood transfusion to the kidneys there is reduction in urine output