Anaesthetics: Sepsis & The Deteriorating Pt

Question 1

Why must we idenitfy a deteriorating pt early?

Answer 1

Early identification & treatment reduces mortality and morbidity

Question 2

What scoring system can we use to help us identify the deteriorating pt?

Answer 2

EWS (early warning score); numerous ones that are modified for different populations e.g.:

• NEWS (national)
• PEWS (paediatric)
• MEWS (modified)

Modifications can be made by clinicians to take into account baseline physiology e.g. Oxygen saturation targets/scoring for those who retain CO2 etc..

Question 3

Compare NEWS and MEWS

Answer 3

Question 4

What scores, in the following scoring sytems, do we get worried about:

• NEWS
• MEWS

Answer 4

• NEWS: above 3 getting worried, =/>5 think sepsis
• MEWS: 4

Question 5

What do ALL sick or deteriorating pts require?

Answer 5

Full A-E examination

Remember:

• Escalate early
• Treat issues as you find them
• Try to get a history if possible
• Repeat!

Question 6

Remind yourself of the definition of sepsis

Answer 6

Life threatening organ dysfunction due to dysregulated host reponse to infection

Question 7

Remind yourself of the defintion of septic shock

Answer 7

Sepsis with lactate >2mmol/l after appropriate fluid resuscitation OR is requiring vasopressors to keep MAP >65mmHg

Question 8

What screening tools can we use to identify sepsis?

Answer 8

qSOFA

SOFA

Question 9

What is the qSOFA score, include:

• What it is used for
• Factors it assess
• Results

Answer 9

qSOFA (quick sofa) is a screening tool/bedside prompt that may identify pts with suspected infection who are at a greater risk for a poor outcome outside the intensive care unit (Identifies patients outside the ICU with suspected infection that are at a high risk for in-hospital mortality).

If you have two or more of the following:

• Resp rate =/> 22/min
• BP = 100
• GCS changed from baseline or less than 15

Increases mortality risk!

Question 10

What is the SOFA score, include:

• What it is used for
• What it assess/includes
• Results

Answer 10

• SOFA (sequential organ failure assessment score) score is used to determine level of organ dysfunction and mortality risk in ICU patients.
• See image for what it includes
• Score:
  
  • 0 - 6 = <10%
  • 7 - 9 = 15 - 20%
  • 10 - 12 = 40 - 50%
  • 13 - 14 = 50 - 60%
  • 15= >80%
  • 16 - 24 = >90%

Question 11

Summarise main differences between qSOFA and SOFA score for sepsis

Answer 11

• qSOFA: pts NOT in ICU- quick tool based on observations
• SOFA: pts IN ICU- uses results from blood gases, blood tests etc..

Question 12

Remind yourself of red flags for sepsis (10)

Answer 12

Question 13

Outline the general principles of management of sepsis

*Not asking specifically for sepsis 6, asking for outline of entire management

Answer 13

• Early identification
• Identify source & source control
• Sepsis 6
• Further management e.g vasopressors
• Organs support e.g. dialysis

Question 14

Remind yourself of the sepsis 6

Answer 14

GIVE THREE, TAKE THREE (BUFALO)

• Blood cultures
• Urine output
• Fluids
• Antibiotics
• Lactate
• Oxygen

Question 15

Sumary from UHL

Question 16

What antibiotic would you give for sepsis?

Answer 16

• 1g Meropenem STAT
• Second dose at 8hrs
• Review at first inpatient consultant assessment; if microbiology results available review & switch to narrower spectrum abx

Question 17

Which pts, with sepsis, would you refer to critical care/ICU?

Answer 17