L30 Sepsis

Question 1

What is Sepsis?

Answer 1

Sepsis is caused by the way the body responds to infection. It can lead to:
- Increased capillary permeability - leading to leakiness of the vessels. This leads to hypotension due to vasodilation. Ultimately it leads to shock which can result in under perfusion.
- Shock can lead to multiorgan failure
Cardiovascular failure and collapse

Question 2

What is Septic Shock?

Answer 2

Septic shock is a subset of sepsis - the worst subset. There is profound circulatory, cellular, and metabolic abnormalities. Therefore you need to identify the infection early one

Question 3

What is SOFA?

Answer 3

Organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of ≥ 2. A higher SOFA indicates a greater severity of illness. Greater than 2, the in-hospital mortality rate is greater than 10%.

Question 4

What organs are affected in multi-organ failure?

Answer 4

• Acute lung injury - may therefore need ventilation
• Cardiovascular instability
• Hypotension - need fluids and vasopressors if the fluids do not working. Until the antibiotics work, recovering the increased endothelial permeability
• Acute Kidney Injury
• Gastrointestinal mucosal injury
• Translocation of bacteria - this can lead to worsening sepsis
Liver dysfunction

Question 5

Which patients are more susceptible to sepsis?

Answer 5

Patients more vulnerable to sepsis according to NICE  
• < 1 year and > 75 years
• Very frail people 
• Recent trauma or surgery or invasive procedure
	• within 6 weeks 
• Impaired immunity due to
	• illness or
	• drugs 
		○ steroids, chemotherapy or  immunosuppressants 
• Indwelling lines / catheters
• Intravenous drug misusers
• Any breach of skin integrity
cuts, burns, blisters or skin infections

Question 6

What does is the A-E approach?

Answer 6

A- Airway 
B- Breathing 
C- Circulation 
D- Disability - looking at neurological function 
E- Exposure

Question 7

What is the response to sepsis?

Answer 7

BUFALO 
B- Blood culture and septic screen 
U- Urine output - monitor hourly also do culture and check urea and electrolytes 
F- Fluid resuscitation 
A- Antibiotics 
L- Lactate 
O- Oxygen to correct hypoxia

Question 8

What test should be carried out on a potentially septic patient?

Answer 8

Tests that should be done are:
- Carry out venous blood test for the following
• blood gas including glucose and lactate measurement
• blood culture
• full blood count
• C‐reactive protein - goes up with bacterial infections and also information so does not necessarily mean bacteria
• urea and electrolytes creatinine
• clotting screen
- Culture
Sputum, urine, wound swab etc.

Question 9

What is true hypovolemia?

Answer 9

When the rate of fluid loss of extra cellular fluid exceeds net intake e.g. in:
○ Hemorrhage
○ Vomiting
○ Diarrhea

Question 10

What is relative hypovolemia?

Answer 10

When there is a decrease in the effective circulating volume e.g. due to Sepsis in vasodilatation.

Question 11

What fluids are given in hypovolemia?

Answer 11

Crystalloids (fluids) we use are:
- 500 mls Hartman’s solution stat
500 mls 0.9% sodium chloride stat