ID - Sepsis

Question 1

Suggest some of the red flags for sepsis.

Answer 1

A:
- RR 25+/min
B:
- new need for >40% O2 to keep sats >91%
C:
- SBP <91 mmHg or fall of 40 from normal
- HR >130/min
- no urine output for 16 hrs of UO <10 ml/hr
D:
- new onset delirium
- responds only to voice of pain/unresponsive
E:
- non-blanching rash/ mottled/ cyanotic/ ashen
- neutropenia or chemotherapy within last 6 wks

Question 2

describe the sepsis 6

Answer 2

1. Supplementary O2 (if required) - aim to keep sats >94% (88-92% in COPD).
2. Take blood cultures, and consider suptum, urine, CSF, line culture/removal
3. IV antibiotics: 1g IV MEROPENEM stat. (+/- 2nd dose at 8 hrs).
4. Fluids, e.g. 500 ml 0.9% NaCl over 15 mins, repeat once if necessary.
5. Measure lactate (ABG or VBG). Refer to critical care if >4 mmol/L. Ensure samples are sent for FBC, CRP, UandE, LFT, coag screen. Repeat lactate after fluid challenge.
6. Measure urine output (ensure hourly fluid balance chart commenced). Catheterise if AKI/ SBP <90/ lactate >2.

Escalate to critical care medical team if necessary.